Regional Treatment for Unresectable Malignant Hepatic Tumors: An Overview of Isolated Hepatic Perfusion

Abstract

For isolated but multiple liver tumors, regional chemotherapy is a reasonable treatment option. Intraarterial chemotherapy can produce significantly higher response rates compared to systemic chemotherapy. Concerning patients with colorectal hepatic metastases, results from recent randomized studies, and metaanalysis of published data indicate that there is a modest but significantly better survival with intraarterial chemotherapy as compared to systemic chemotherapy. These data and strikingly improved results on isolated limb perfusion using melphalan and tumor necrosis factor (TNF) stimulated renewed interest in isolated hepatic perfusion (IHP) by surgical isolation. The results of phase I and phase II studies with melphalan and TNF agree that IHP can produce high tumor response rates and long progressionfree intervals in responding patients. However, IHP requires an extensive surgical procedure, and its repetitive application in one patient is difficult. As a minimally invasive and repeatable form of IHP, percutaneous techniques of IHP (PIHP) have been developed in the past decade. In phase I and phase II trials, repetitive PIHP has proved to be effective for local control of multiple liver tumors. Its combination with reductive surgery produced spectacular local control of previously unresectable liver tumors. However, either IHP technique remains to be, as yet, a therapeutics which should only be performed on a controlled study basis.