Hepatic artery infusion for metastatic neoplastic disease

Specific conclusions can be drawn concerning HAI in the treatment of neoplastic hepatic disease. Over-all, a rate of response of 50 per cent is noted, with the results of more recent studies showing improved response rates as measured by a CEA marker. There are extremely few, if any, complete responders. Nonresponders have one-half the survival time of responders. The median time of survival in patients who have received HAI is about one year. There have been series in which the mean survival rate is greater than that in historical control patients, but no one has demonstrated this fact with a matched group of patients in a prospective controlled trial; many such controlled trials are now underway. The duration of survival in patients receiving treatment is strongly influenced by the development and progression of extrahepatic lesions. Placing HAI catheters by laparotomy is more dangerous to life, but the morbidity is higher with percutaneous HAI. On the other hand, patients treated percutaneously have a much higher incidence of thrombosis of the hepatic artery and of other problems related to the catheter, including migration and dislodgment, so that treatment is compromised. The high numbers of patients treated by percutaneous therapy in the past who had an increased incidence of thrombosis of the hepatic artery perhaps have had some influence on the response rate. The technology of HAI has improved rapidly and markedly during the last several years with the development of such pumps with advanced design as the totally implantable, refillable and rechargeable infusion pump. What is needed now are studies designed to determine the best agent or combination of agents that can be administered through these advanced systems. Long term, controlled clinical trials of HAI in the ambulatory patient are underway, but the results are not yet available.