Hyperthermic isolated hepatic perfusion for the treatment of unresectable cancers confined to the liver

Abstract

Dear Sir,We read with interest the review of the status of hyperthermia in the treatment of liver cancer by Moroz and colleagues in a recent issue of the Journal of Surgical Oncology [1]. The authors concluded, ''the results of trials involving IHP (isolated hepatic perfusion) hitherto have been disappointing'' and that ''it is difficult to envisage a role for IHP in the treatment of liver cancer.'' We have been actively evaluating the use of IHP over the past 8 years and were disappointed not to see any reference to our published work by the authors. We would agree, based on the cited references in the article, that some results with IHP have been disappointing. We have tried to place those trials in perspective with several reviews on this topic that address the current results of IHP from various centers [2][3][4][5][6]. We disagree that there are other treatments such as local ablative therapies or systemic chemotherapy that are ''more effective and safer.'' All patients treated with IHP at our institution are not candidates for local ablative treatment based on size, number, and location of lesions in the liver and, except for those with ocular melanoma, most have failed previous systemic or regional chemotherapy.We have also published results of several prospectively conducted phase I and II trials to define the utility of tumor necrosis factor (TNF) and melphalan administered as a one hour hyperthermic IHP. Our initial results with TNF and melphalan showed a 74% radiograpic response rate (RR) in 33 assessable patients with unresectable metastases confined to liver [7]. We subsequently reported that using a standard operative technique that complete vascular isolation is routinely achieved with IHP and that, with or without TNF, this therapy can be administered with minimal morbidity and a mortality of less than 4% [6,8]. IHP appears to have significant anti-tumor activity against a variety of histologies. Our initial results in 22 patients with ocular melanoma metastatic to liver who underwent hyperthermic IHP demonstrated an overall RR of 62% [9] and more recent unpublished results show an overall RR of 71%. Our experience in 51 patients with unresectable hepatic metastases from colorectal cancer who underwent IHP has also been reported [10]. Half of the patients in this study had failed prior systemic therapy and seven had failed prior hepatic arterial infusional therapy (HAI). The overall objective RR was 76%. Of note, in those receiving IHP followed by post-IHP HAI of a floxuridine-based regimen the median duration of response was over 14 months and median survival was 27 months. There was only one peri-operative death. Based on these data, we believe that continued clinical evaluation to better define the role of IHP in the treatment of patients with unresectable cancers confined to liver is justified.

Surgical treatment of non‐functioning pancreatic islet cell tumors

“…In principle, this technique delivers radioactive particles through the HA into the tumor rather than the normal hepatic parenchyma, resulting in a favorable tumor to normal uptake ratio and without liver complications [193,196]. Finally, isolation perfusion of the liver for metastatic PETs, as performed at the National Cancer Institute, also remains an investigational procedure [197,198].…”