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From the Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands (BvE, FB, MGAvI, CV, JHWdW, AMME); Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands (AWKSM); Department of Surgery, VU Medical Center, Amsterdam, The Netherlands (JRMvdS); Laboratory of Experimental Oncology, University of Leuven-Hospital Gasthuisberg, Leuven, Belgium (GG, GdB, EAdB); and Department of Chemistry, University of Antwerpe, Wilrijk, Belgium (GG).
Correspondence: Address correspondence and reprint requests to: Alexander M. M. Eggermont, MD, PhD, Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, PO Box 5201, 3008 AE Rotterdam, The Netherlands; Fax: 31-10-439-1011; E-mail: a.m.m.eggermont{at}erasmusmc.nl
Background: Isolated hepatic perfusion for irresectable metastases confined to the liver has reported response rates of 50% to 75%. Magnitude, costs, and nonrepeatability of the procedure are its major drawbacks. We developed a less invasive, less costly, and potentially repeatable balloon catheter–mediated isolated hypoxic hepatic perfusion (IHHP) technique.
Methods: In this phase I and II study, 18 consecutive patients with irresectable colorectal or ocular melanoma hepatic metastases were included. Two different perfusion methods were used, both with inflow via the hepatic artery, using melphalan 1 mg/kg. In the first eight patients, the portal vein was occluded, and outflow was via the hepatic veins into an intracaval double-balloon catheter. This orthograde IHHP had on average 56% leakage. In next 10 patients, we performed a retrograde outflow IHHP with a triple balloon blocking outflow into the caval vein and allowing outflow via the portal vein. The retrograde IHHP still had 35% leakage on average.
Results: Although local drug concentrations were high with retrograde IHHP, systemic toxicity was still moderate to severe. Partial responses were seen in 12% and stable disease in 81% of patients. The median time to local progression was 4.8 months.
Conclusions: We have abandoned occlusion balloon methodology for IHHP because it failed to obtain leakage control. We are presently conducting a study using a simplified surgical retrograde IHHP method, in which leakage is fully controlled, which translates into high response rates.
Key Words: Liver metastases • Isolated hepatic perfusion • Melphalan • Balloon catheter • Phase I and II study • Percutaneous
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