Transcatheter Embolization for the Treatment of Misperfusion After Hepatic Artery Chemoinfusion Pump Implantation

Bloom, Allan I.; Gordon, Roy L.; Ahl, Katherin H.; Kerlan, Robert K.; LaBerge, Jeanne M.; Wilson, Mark W.; Venook, Alan P.; Warren, Robert S.

doi:10.1007/s10434-999-0350-7

Cited by 17 publications

(9 citation statements)

References 9 publications

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“…Nuclear medicine physicians are required to conduct and interpret nuclear scintigraphy studies to ensure that extrahepatic perfusion is avoided. When extrahepatic perfusion is detected or when catheter-related complications occur, treatment can be salvaged with advanced interventional radiology techniques 33,34 . Finally, given the complexity of the care coordination and the frequency of tests and treatment in patients receiving haip therapy, dedicated nursing support is paramount to support a haip program.…”

Section: Institutional Requirements For Haip Therapymentioning

confidence: 99%

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Karanicolas¹,

Metrakos²,

Chan³

et al. 2013

Curr. Oncol.

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KEY WORDSColorectal metastases, liver metastases, unresectable metastases, adjuvant chemotherapy, intraarterial chemotherapy, hepatic arterial infusion pump chemotherapy BACKGROUNDOver the past several years, important progress has been made in the treatment of patients with metastatic colorectal cancer. Median overall survival in these patients now extends beyond 2 years with a combination of modern systemic therapies [1][2][3][4][5][6][7][8] . Approximately 60% of patients present with liver-only or liver-predominant metastases, and if complete surgical resection is achieved in those patients, 5-year overall survival approaches 50% 9-11 . In patients with initially unresectable colorectal liver metastases (crlms), systemic therapy can, in up to 30% of patients, produce a tumour response sufficient to allow for resection and the possibility of long-term survival or cure 12,13 . An important goal of aggressive therapy in patients with initially unresectable crlms is therefore conversion to resectability.Although the response rate to systemic therapy is good in untreated patients, response rates to chemotherapy in the second-line setting remain disappointing. The most encouraging results are obtained with the addition of biologic agents to chemotherapy, achieving response rates of up to 20%-35% and a corresponding median survival of up to 1 year in the second-line setting [14][15][16][17][18] . Given the limited efficacy of systemic therapy beyond the first-line setting, patients could benefit from other treatments that would increase response and resectability rates.Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms. The rationale for arterial delivery of ABSTRACT Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used.We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements:• haip chemotherapy should be given in combination with systemic chemotherapy.• haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.• haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.• haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.• haip chemotherapy in combination with systemic therapy is an option for select pati...

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Section: Institutional Requirements For Haip Therapymentioning

confidence: 99%

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Karanicolas¹,

Metrakos²,

Chan³

et al. 2013

Curr. Oncol.

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“…2) and to rule out any arteriovenous shunting. Extrahepatic perfusion should be confirmed with an arteriogram, and the culprit vessel should be embolized, if possible [27]. Early pump-related complications are uncommon (5%-10%) and usually technically related, including hepatic artery thrombosis, pump pocket hematomas, wound infections, underperfusion of liver, and/or extrahepatic perfusion.…”

Section: Pump Placementmentioning

confidence: 99%

An Update on Hepatic Arterial Infusion Chemotherapy for Colorectal Cancer

Cohen

Kemeny

2003

The Oncologist

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Hepatic metastases are a frequent complication of colorectal cancer (CRC), affecting over half of all CRC patients. Resection of isolated metastases can result in long-term survival, but the majority of patients relapse, and most have unresectable disease. Hepatic arterial infusion (HAI) chemotherapy delivers high concentrations of cytotoxic agents directly to liver metastases with minimal systemic toxicities. Advances in surgical techniques, development of fully implantable pumps, and modification of drug regimens have decreased complications and improved patient tolerability. Randomized trials comparing HAI with systemic chemotherapy have demonstrated superior response rates and times to hepatic progression for unresectable disease, and have shown better times to progression and overall survival rates in the adjuvant setting following hepatic resection. HAI chemotherapy has unique toxicities, including chemical hepatitis and biliary sclerosis, which can be mitigated by the addition of dexamethasone to therapy. In an attempt to prevent extrahepatic progression, combinations of HAI with systemic chemotherapy, including newer agents such as irinotecan and oxaliplatin, are currently being investigated, with promising early results.

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“…Bloom et al [14] reported 16 patients with liver metastasis from colorectal carcinoma and HAIC misperfusion. They separated the patients in two groups, extrahepatic (n=8) and intrahepatic (n=8) misperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Gastroduodenal endoscopy allows the distribution of the ulcers in the territories of the misperfused arteries to be confirmed. The use of methylene blue administration via the arterial port during endoscopy has been used to establish gastroduodenal misperfusion from HAIC [13,14]. Gastroduodenal abnormalities ranged from typical benign ulcers to a pattern of epithelial atypia and multiple ulcerations that may be falsely considered malignant [6].…”

Section: Discussionmentioning

confidence: 99%

Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy

et al. 2007

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Transcatheter Embolization for the Treatment of Misperfusion After Hepatic Artery Chemoinfusion Pump Implantation

Abstract: Transcatheter coil embolization is the therapy of choice for the management of hepatic artery chemoinfusion pump misperfusion. It is rapid, effective, and well tolerated by patients and obviates the need for additional surgical intervention.

Cited by 17 publications

References 9 publications

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

An Update on Hepatic Arterial Infusion Chemotherapy for Colorectal Cancer

Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy

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