Percutaneous hepatic perfusion with melphalan for unresectable liver metastasis

Abstract

Percutaneous hepatic perfusion (PHP) is an investigative technique for treating patients with diffuse unresectable metastatic liver disease. The technique has been clinically evaluated and shows great treatment potential for regional therapy to the liver. The advantage of PHP lies in its minimally invasive approach and ability to be repeated when compared to isolated hepatic perfusion. In a literature search, 135 publications were screened and 16 of these publications, including clinical trials and reviews, contributed to this review of PHP with melphalan. Melphalan is an alkylating agent that, when used as the chemotherapeutic agent in PHP, has shown potential for significant control of tumor burden in the liver, especially in metastatic ocular melanoma. In the current landscape of liver directed therapy, PHP is a viable option for those with unresectable metastatic disease to the liver. This article will focus on the technical aspects of PHP and describe the current data available from clinical trials, including outcomes of patients treated with this minimally invasive approach.

Meta-Analysis of Isolated Hepatic Perfusion and Percutaneous Hepatic Perfusion as a Treatment for Uveal Melanoma Liver Metastases

“…Longer OS for PHP was to be expected as repeated procedures are possible and were performed in most patients, but this was not shown by the data. It might be that the normothermic perfusion during PHP is less effective than the hyperthermic perfusion during IHP [ 66 ]. This hypothesis can be supported by the fact that significantly more patients have a complete response after IHP, although this does not lead to a significantly longer hPFS for IHP.…”