Percutaneous Hepatic Perfusion in Patients with Metastatic Liver Cancer: Anesthetic, Hemodynamic, and Metabolic Considerations

Miao, Ning; Pingpank, James F.; Alexander, H. Richard; Steinberg, Seth M.; Beresneva, Tatiana; Quezado, Zenaide M.N.

doi:10.1245/s10434-007-9781-1

Cited by 43 publications

(29 citation statements)

References 8 publications

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“…All patients will experience hypotension at two points during the procedure: when the venous balloons are inflated and when the filters in the bypass circuit are activated [37]. The blood pressure decrease is managed with prehydration, intraoperative fluid boluses, and IV vasopressors until blood pressure normalizes.…”

Section: Cs-php Proceduresmentioning

confidence: 99%

Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

et al. 2016

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The Hepatic CHEMOSAT® Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile. Funding: Delcath Systems Inc., New York, NY, USA.

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Section: Cs-php Proceduresmentioning

confidence: 99%

Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

et al. 2016

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“…This second episode of hypotension is attributed to potential depletion of circulating catecholamines and usually required treatment with vasopressors. Significant decreases in pH were also seen during perfusion, and in one protocol, sodium bicarbonate was given to treat metabolic acidosis if the pH dropped below 7.3 [87]. …”

Section: Percutaneous Hepatic Perfusionmentioning

confidence: 99%

Minimally invasive intra-arterial regional therapy for metastatic melanoma: isolated limb infusion and percutaneous hepatic perfusion

Han

Beasley

Tyler

et al. 2011

Expert Opinion on Drug Metabolism & Toxicology

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Introduction In-transit melanoma or melanoma presenting as unresectable liver metastases are clinical situations with limited therapeutic options. Regional intra-arterial therapies provide efficacious treatment alternatives for these patients. Through surgical techniques of vascular isolation, regional therapies deliver high-dose chemotherapy to tumor cells while minimizing systemic exposure. However, percutaneous techniques such as isolated limb infusion (ILI) and percutaneous hepatic perfusion (PHP) have been developed, which provide a minimally invasive means of obtaining vascular isolation of target organs. Areas covered Areas covered in this review include the techniques of ILI and PHP, the chemotherapeutic agents utilized during these regional therapies and the clinical responses seen after ILI and PHP. The pharmacokinetics of regional chemotherapy utilized during ILI and PHP is also reviewed with an additional focus on novel ways to optimize drug delivery to improve response rates and attempts to define the potential systemic manifestations of regional therapeutics. Expert opinion Unresectable hepatic and limb in-transit metastases from melanoma are very difficult to treat. Systemic chemotherapy has largely been ineffective. Both the minimally invasive, percutaneous techniques of ILI and PHP are excellent methods used to deliver extremely high-dose chemotherapy regionally to patients harboring metastatic melanoma confined to an extremity or liver, respectively. Studies, from prospectively maintained databases as well as Phase II and III trials, have shown the great efficacy of these techniques.

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“…Acidosis has also been observed requiring the administration of intravenous sodium bicarbonate. [12] Therefore, PHP must be done with a welltrained, experienced, and coordinated multidisciplinary team consisting of a vascular surgeon or interventional radiologist, anesthesiologist, and physicians that can safely manage the effects from the procedure and chemotherapy in a closely monitored setting.…”

Section: Php Vs Ihpmentioning

confidence: 99%

Percutaneous hepatic perfusion with melphalan for unresectable liver metastasis

Quadri¹,

Payabyab²,

Chen³

et al. 2016

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Percutaneous hepatic perfusion (PHP) is an investigative technique for treating patients with diffuse unresectable metastatic liver disease. The technique has been clinically evaluated and shows great treatment potential for regional therapy to the liver. The advantage of PHP lies in its minimally invasive approach and ability to be repeated when compared to isolated hepatic perfusion. In a literature search, 135 publications were screened and 16 of these publications, including clinical trials and reviews, contributed to this review of PHP with melphalan. Melphalan is an alkylating agent that, when used as the chemotherapeutic agent in PHP, has shown potential for significant control of tumor burden in the liver, especially in metastatic ocular melanoma. In the current landscape of liver directed therapy, PHP is a viable option for those with unresectable metastatic disease to the liver. This article will focus on the technical aspects of PHP and describe the current data available from clinical trials, including outcomes of patients treated with this minimally invasive approach.

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Percutaneous Hepatic Perfusion in Patients with Metastatic Liver Cancer: Anesthetic, Hemodynamic, and Metabolic Considerations

Cited by 43 publications

References 8 publications

Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

Minimally invasive intra-arterial regional therapy for metastatic melanoma: isolated limb infusion and percutaneous hepatic perfusion

Percutaneous hepatic perfusion with melphalan for unresectable liver metastasis

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