Chemosaturation with percutaneous hepatic perfusion for unresectable metastatic melanoma or sarcoma to the liver: A single institution experience

Abstract

Background Patients with unresectable melanoma or sarcoma hepatic metastasis have a poor prognosis with few therapeutic options. Percutaneous hepatic perfusion (PHP), isolating and perfusing the liver with chemotherapy, provides a promising minimally invasive management option. We reviewed our institutional experience with PHP. Methods We retrospectively reviewed patients with unresectable melanoma or sarcoma hepatic metastasis treated with PHP from 2008 to 2013 and evaluated therapeutic response, morbidity, hepatic progression free survival (hPFS), and overall survival (OS). Results Ten patients were treated with 27 PHPs (median 3). Diagnoses were ocular melanoma (n=5), cutaneous melanoma (n=3), unknown primary melanoma (n=1), and sarcoma (n=1). Median hPFS was 240 days, 9 of 10 patients (90%) demonstrated stable disease or partial response to treatment. At a median follow up of 11.5 months, 4 of 10 (40%) remain alive. There were no perioperative mortalities. Myelosuppresion was the most common morbidity, managed on an outpatient basis with growth factors. The median hospital stay was 3 days. Conclusions Patients with metastatic melanoma and sarcoma to the liver have limited treatment options. Our experience with PHP demonstrates promising results with minimal morbidity and should be considered (pending FDA approval) as a management option for unresectable melanoma or sarcoma hepatic metastasis.

Chemosaturation with Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases

“…7,8,[10][11][12][13] The report from Abbot et al 11 is an update of the study results from Forster et al, 7 so these data are combined in our review. Likewise, some study patients reported in Hughes et al 10 were included in Abbot et al, 11 so we also omitted those case patients from inclusion in our review of the results from Abbot et al 11 and Forster et al 7 No data from Pingpank et al 14 were utilized because this report included preliminary results from a randomized control trial eventually published by Hughes et al…”

“…1 Hepatic metastases can also co-occur with many other malignancies, such as breast cancer, renal cell cancer, cutaneous melanoma, and soft-tissue sarcoma. 7,8 For patients with unresectable liver-dominant disease, multiple strategies for liver-directed therapy have been developed, including hepatic artery chemoembolization, radioactive bead embolization, hepatic arterial infusion, isolated hepatic infusion, and chemosaturation with percutaneous hepatic perfusion. 3 In Europe, chemosaturation with percutaneous hepatic perfusion was commercially launched in 2012, and a second-generation, high-efficiency filter was approved for use in conjunction with a proprietary hepatic delivery system that same year.…”

Percutaneous hepatic perfusion with melphalan for unresectable liver metastasis

“…Another trial described by Forster et al [13] retrospectively reviewed patients treated with PHP at their single institution over a 7 years period. The patients included those with unresectable melanoma or sarcoma hepatic metastases.…”

“…Nine of 10 (90%) patients treated had stable disease (SD) or a PR, with a median partial response of a 33% decrease in tumor burden from baseline. [13] The median follow up for the evaluation was 11.5 months in which the hepatic progression free survival (hPFS) was 240 days. At last 60% of the patients treated at the institution died from their disease.…”

“…The authors concluded from these results that for select patients with unresectable melanoma or sarcoma hepatic metastases, PHP is a safe and promising management option. [13] European experience…”