Over 12 Years Single Institutional Experience Performing Percutaneous Hepatic Perfusion for Unresectable Liver Metastases

Abstract

Patients with unresectable hepatic metastases, from uveal or ocular melanoma, are challenging to treat with an overall poor prognosis. Although over the past decade significant advances in systemic therapies have been made, metastatic disease to the liver, especially from uveal melanoma, continues to be a poor prognosis. Percutaneous hepatic perfusion (PHP) is a safe, viable treatment option for these patients. PHP utilizes high dose chemotherapy delivered directly to the liver while minimizing systemic exposure and can be repeated up to 6 times. Isolation of the hepatic vasculature with a double-balloon catheter allows for high concentration cytotoxic therapy to be administered with minimal systemic adverse effects. A detailed description of the multidisciplinary treatment protocol used at an institution with over 12 years of experience is discussed and recommendations are given. A dedicated team of a surgical or medical oncology, interventional radiology, anesthesiology and a perfusionist allows PHP to be repeatedly performed as a safe treatment strategy for unresectable hepatic metastases.

Percutaneous Hepatic Perfusion (PHP) with Melphalan in Liver-Dominant Metastatic Uveal Melanoma: The German Experience

“…Our results are not only similar to these preliminary response rates but also in line with current (mostly monocentric and retrospective) studies evaluating response and survival after PHP in UM [ 27 , 28 , 35 , 37 , 38 ].…”

“…With effective systemic therapies for metastatic UM still lacking [ 34 ], locoregional liver therapies can offer a promising alternative. Intraarterial approaches (such as PHP, TACE, and TARE) take advantage of the unique hepatic vascular supply: as liver metastases derive their blood solely from the hepatic artery—whereas normal liver is predominantly supplied by the portal vein—intraarterially administered drugs can bypass the non-diseased hepatic parenchyma [ 35 ]. In addition, with PHP, systemic toxicity is minimized by extracorporeal filtration.…”

“…The safety of TARE with Yttrium-90 has been demonstrated in small cohorts of patients with metastatic cutaneous or uveal melanoma, with median OS rates ranging from 8 to 10 months [ 35 , 39 ]. Median OS with TACE in metastatic UM has been reported of up to 4–9 months [ 35 , 40 ].…”

“…The safety of TARE with Yttrium-90 has been demonstrated in small cohorts of patients with metastatic cutaneous or uveal melanoma, with median OS rates ranging from 8 to 10 months [ 35 , 39 ]. Median OS with TACE in metastatic UM has been reported of up to 4–9 months [ 35 , 40 ]. In a retrospective comparison of survival data from 30 patients with ocular and uveal melanoma, Abbott et al [ 18 ] found significantly prolonged hepatic PFS, overall PFS, and OS in patients treated with PHP (hPFS: 361 days; PFS: 245 days; OS: 608 days) compared to patients treated with TACE (hPFS and PFS: 52 days; OS: 265 days) or TARE (hPFS and PFS: 54 days; OS 295 days).…”

Immediate results of treatment of patients with metastatic uveal melanoma using isolated liver chemoperfusion. The first domestic experience

“…К недостаткам процедуры следует отнести ее техническую сложность и высокие показатели послеоперационных осложнений, связанных с утечкой химиопрепарата во время ее выполнения [31]. Для уменьшения травматичности процедуры проводятся исследования с применением минимально инвазивных методик проведения ИХП [32][33][34][35][36].…”