Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center.

Abstract

AIM:

To define the indications for hyperthermic isolated hepatic perfusion (IHP) in patients with unresectable liver metastases (LM) from colorectal cancer (CRC) with particular focus on IHP's utility as a second-line option for patients whose tumors have progressed following combination systemic chemotherapy treatment.

METHODS:

From June 1994 through July 2005, 120 patients with unresectable CRC LM underwent IHP with melphalan (n = 69), tumor necrosis factor (TNF) (n = 10) or both (n = 41). Hepatic arterial infusion (HAI) with floxuridine started 6-8 weeks post IHP in 46 (38%). Patients were followed for toxicity, radiographic response, and overall survival (OS). Wilcoxon rank-sum and Fisher's exact tests were used to compare parameters by response category; survival and hepatic progression-free survival were calculated by the Kaplan-Meier method.

RESULTS:

Of 79 males and 41 females, 96 (80%) received prior chemotherapy. There were five (4%) operative/treatment mortalities. There were 69 responses in 114 evaluable patients (61%). Total melphalan dose and combination melphalan/TNF were each associated with response; age, preoperative carcinoembryonic antigen (CEA), prior chemotherapy for established LM, tumor burden, and post-IHP HAI therapy were not. Median overall survival was 17.4 months and 2-year survival was 34%. Factors found to be independently related to survival were preoperative CEA <30 ng/mL and use of post-IHP HAI (P < 0.015).

CONCLUSIONS:

IHP results in marked tumor regression and prolonged survival in patients with CRC LM. Continued development of IHP in this clinical setting is warranted.

• Authors: H Richard Alexander Jr, David L Bartlett, Steven K Libutti, James F Pingpank, Douglas L Fraker, Richard Royal, Seth M Steinberg, Cynthia B Helsabeck, Tatiana H Beresneva
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 16 Issue 7 Pg. 1852-9 (Jul 2009) ISSN: 1534-4681 [Electronic] United States
• PMID: 19434456 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage)
• Chemotherapy, Cancer, Regional Perfusion
• Colorectal Neoplasms (pathology)
• Disease Progression
• Female
• Humans
• Hyperthermia, Induced
• Liver Neoplasms (drug therapy, secondary)
• Male
• Middle Aged
• Treatment Failure
• Treatment Outcome
• Young Adult