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Percutaneous isolated hepatic perfusion for chemotherapy: a phase 1 study
Eric Savier1, Daniel Azoulay, Emmanuel Huguet
1Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, 94800 France. eric.savier@psl.ap-hop-paris.fr
Archives of Surgery (Chicago, Ill. : 1960)
|March 4, 2003
Summary
Percutaneous isolated hepatic perfusion (IHP) delivers high-dose chemotherapy directly to liver tumors, offering a less aggressive and safer alternative to open surgery. This iterative approach shows promise for chemoresistant hepatic malignancies.
Area of Science:
- Oncology
- Surgical Oncology
- Hepatic Therapies
Background:
- High drug concentrations in tumors can enhance treatment response.
- Hepatic vascular isolation techniques enable localized chemotherapy delivery.
- Isolated Hepatic Perfusion (IHP) aims to maximize drug exposure in the liver while minimizing systemic toxicity.
Observation:
- Complete percutaneous isolated hepatic perfusion (IHP) was evaluated in a case series of 10 patients with unresectable, chemoresistant liver tumors.
- Patients received up to three courses of melphalan chemotherapy via IHP, with initial treatment at laparotomy and subsequent treatments percutaneously.
- Percutaneous IHP achieved high drug concentrations in the liver with minimized hepatotoxicity compared to laparotomy-based IHP.
Findings:
- Ten IHPs were performed, with 6 via percutaneous approach.
- Melphalan concentrations were 10-fold higher in the extracorporeal circuit than systemically.
- While percutaneous IHP showed increased leakage, it resulted in minimized hepatotoxicity. Observed complications included hepatic artery thrombosis and neutropenia; no deaths occurred within two months post-treatment. One partial response was noted in breast cancer metastases.
Implications:
- Percutaneous IHP is a feasible and safer alternative for intensive chemotherapy in liver tumors.
- The iterative nature of percutaneous IHP allows for repeated treatments.
- This technique may improve outcomes for patients with chemoresistant hepatic malignancies.