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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2008

Open Access 01-07-2008 | Gastrointestinal Oncology

Isolated Hepatic Perfusion with 200 mg Melphalan for Advanced Noncolorectal Liver Metastases

Authors: Liselot B. J. van Iersel, MD, Ellen J. Hoekman, Hans Gelderblom, MD, PhD, Alexander L. Vahrmeijer, MD, PhD, Els L. van Persijn van Meerten, MD, Fred G. J. Tijl, Henk H. Hartgrink, MD, PhD, Peter J. K. Kuppen, PhD, Johan W. R. Nortier, MD, PhD, Rob A. E. M. Tollenaar, MD, PhD, Cornelis J. H. van de Velde, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2008

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Abstract

Purpose

The liver is one of the most common sites for metastatic solid tumors. If the liver is the only site of metastatic disease, regional treatment options can offer the benefit of high local exposure with limited systemic toxicity, especially for patients without (further) systemic treatment options. We report the results of our experience with isolated hepatic perfusion (IHP) in patients with isolated liver metastases from a variety of primary tumors.

Patients and Methods

Nineteen patients with isolated unresectable liver metastases from a variety of tumors (13 uveal melanomas, 2 neuroendocrine carcinomas, 2 gastrointestinal stromal tumors, 1 hepatocellular carcinoma, and 1 high-grade sarcoma) were treated with a 60-min IHP using 200 mg melphalan. Patients were monitored for toxicity, response according to response evaluation criteria in solid tumors (RECIST) criteria, and survival.

Results

One melanoma patient was not perfused due to insufficient isolation of the liver. There was no treatment-related mortality. Reversible grade 3 or 4 hepatoxicity occurred in 10 (56%) patients, while veno-occlusive disease occurred in 4 (22%) patients. Of the 12 uveal melanoma patients who were perfused, 4 (33%) patients had a partial hepatic response, 6 (50%) patients had stable hepatic disease, and 2 (17%) patients were immediately progressive. Median disease-free survival was 6.6 months with a median overall survival of 10.0 months. Fifty percent of other primary tumors showed at least partial remission, including one complete remission in a high-grade sarcoma patient.

Conclusion

IHP with melphalan shows activity in patients with liver metastases from a variety of primary tumors, but other or additional drugs may improve therapeutic outcome.
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Metadata
Title
Isolated Hepatic Perfusion with 200 mg Melphalan for Advanced Noncolorectal Liver Metastases
Authors
Liselot B. J. van Iersel, MD
Ellen J. Hoekman
Hans Gelderblom, MD, PhD
Alexander L. Vahrmeijer, MD, PhD
Els L. van Persijn van Meerten, MD
Fred G. J. Tijl
Henk H. Hartgrink, MD, PhD
Peter J. K. Kuppen, PhD
Johan W. R. Nortier, MD, PhD
Rob A. E. M. Tollenaar, MD, PhD
Cornelis J. H. van de Velde, MD, PhD
Publication date
01-07-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-9881-6

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