REGULAR CONTENT
Final ID
487
Type
Original Scientific Research-Oral or Pos
Authors
S Marquardt1, M Kirstein2, A Vogel2, F Wacker1
Institutions
1Dept. of Diagnostic and Interventional Radiology, Hannover, Germany, 2Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany
Purpose
To assess feasibility, efficacy, and safety of percutaneous hepatic perfusion (PHP) as salvage therapy in patients with primary or secondary liver tumors.
Materials & Methods
Regional therapy for patients with liver tumors includes percutaneous ablation, TACE and SIRT. Recently a minimal invasive percutaneous system has been introduced that uses a double-balloon catheter for isolation of the hepatic inferior caval vein segment. During arterial chemoperfusion of the liver with melphalan venous blood of the liver is extracted through the double-balloon catheter and filtrated via an extracorporeal hemofiltration circuit before it is given back into the internal jugular vein.We retrospectively reviewed data from 29 patients with hepatic metastasis from ocular melanoma (n=11), periampular carcinoma (n=2), colorectal (n=2), pancreatic (n=2), breast (n=1) and uterine cancer (n=1) as well as patients with primary hepatocellular carcinoma (n=5) and cholangiocarcinoma (n=5) who received up to 5 treatments of PHP under general anesthesia at one tertiary care center. Technical success, periinterventional complications, adverse effects and tumor response (RECIST criteria) were evaluated.
Results
Technical success was achieved in all procedures. Perininterventional complications included dissection of the common hepatic artery, treated with angioplasty, and minor bleeding at access sites in 3 patients. Complications from bone marrow suppression were common but reversible. This includes grade 3/4 thrombopenia in 14 (48.3%), leukopenia in 7 (24.1%) and grade 3 anemia in 7 (24.1%) patients. Substitution of platelets, erythrocytes or administration of G-CSF was necessary in 41.4%, 37.9% and 41.4% of these patients. After a follow-up period of 2 months local response (SD or PR) was observed in 20 patients (69.0%). 6 patients showed PD. 2 patients died shortly after PHP due to sepsis and tumor progression respectively. 1 patient was lost to follow-up.
Conclusions
PHP is technically feasible and patients with progression of liver tumors undergoing standard therapy may benefit. Despite frequent salvage situations good outcomes were observed with ocular melanoma metastasis and cholangiocarcinoma. Complications are manageable
Final ID
487
Type
Original Scientific Research-Oral or Pos
Authors
S Marquardt1, M Kirstein2, A Vogel2, F Wacker1
Institutions
1Dept. of Diagnostic and Interventional Radiology, Hannover, Germany, 2Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany
Purpose
To assess feasibility, efficacy, and safety of percutaneous hepatic perfusion (PHP) as salvage therapy in patients with primary or secondary liver tumors.
Materials & Methods
Regional therapy for patients with liver tumors includes percutaneous ablation, TACE and SIRT. Recently a minimal invasive percutaneous system has been introduced that uses a double-balloon catheter for isolation of the hepatic inferior caval vein segment. During arterial chemoperfusion of the liver with melphalan venous blood of the liver is extracted through the double-balloon catheter and filtrated via an extracorporeal hemofiltration circuit before it is given back into the internal jugular vein.We retrospectively reviewed data from 29 patients with hepatic metastasis from ocular melanoma (n=11), periampular carcinoma (n=2), colorectal (n=2), pancreatic (n=2), breast (n=1) and uterine cancer (n=1) as well as patients with primary hepatocellular carcinoma (n=5) and cholangiocarcinoma (n=5) who received up to 5 treatments of PHP under general anesthesia at one tertiary care center. Technical success, periinterventional complications, adverse effects and tumor response (RECIST criteria) were evaluated.
Results
Technical success was achieved in all procedures. Perininterventional complications included dissection of the common hepatic artery, treated with angioplasty, and minor bleeding at access sites in 3 patients. Complications from bone marrow suppression were common but reversible. This includes grade 3/4 thrombopenia in 14 (48.3%), leukopenia in 7 (24.1%) and grade 3 anemia in 7 (24.1%) patients. Substitution of platelets, erythrocytes or administration of G-CSF was necessary in 41.4%, 37.9% and 41.4% of these patients. After a follow-up period of 2 months local response (SD or PR) was observed in 20 patients (69.0%). 6 patients showed PD. 2 patients died shortly after PHP due to sepsis and tumor progression respectively. 1 patient was lost to follow-up.
Conclusions
PHP is technically feasible and patients with progression of liver tumors undergoing standard therapy may benefit. Despite frequent salvage situations good outcomes were observed with ocular melanoma metastasis and cholangiocarcinoma. Complications are manageable