[Control of perfusion by angioscintigraphy during hepatic intra-arterial chemotherapy]

Intra-arterial hepatic chemotherapy is effective in the treatment of liver metastases, and it has been used at the Gustave Roussy Institute since 1983. During laparotomy, arterial catheters are introduced usually into the gastroduodenal artery, and they are connected either to a subcutaneous access or to an implantable pump. Seventy-one patients with liver metastases from colorectal adenocarcinoma were examined by angioscintigraphy to evaluate the quality of liver perfusion. Our technique uses three radioactive compounds and makes it possible to obtain a standard liver scintigram with technetium 99-colloidal rhenium sulphur, a dynamic view of liver arterial perfusion by injection of pure technetium 99 pernechtate, and a static mapping of well-perfused territories after injection of technetium 99-labelled macroaggregated albumin. This technique is reliable to explain most of the problems encountered during intra-arterial hepatic chemotherapy. In our experience, the quality of perfusion was highly variable and had a prognostic value. Objective responses were more frequent in well-vascularized metastases (64 percent) than in metastases with hypoperfusion (36 percent). Survival was also better in the former case, with a median survival of 18 months as against 12 months (p = 0.028).