scholarly journals Hepatic Artery Infusion Pump Combined With Systemic Chemotherapy for Patients With Liver Metastases From Breast Carcinoma

2021 ◽  
Vol 20 ◽  
pp. 153303382110515
Author(s):  
Hong-Bing Shi ◽  
Wei-Guang Qiang ◽  
Wei-Liang Zhu ◽  
Ye Yuan ◽  
Jun-Jun Wang ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Infusion Pump ◽  
Young Patients ◽  
Hepatic Arterial Infusion ◽  
Hepatic Artery Infusion ◽  
Kaplan Meier ◽  
Extrahepatic Metastases ◽  
Grade 3

Background: When liver metastasis in patients with breast cancer is diagnosed, treatment is generally palliative and usually consists of systemic therapies only. This study aimed to evaluate the efficacy and safety of hepatic arterial infusion (HAI) combined with systemic chemotherapy in patients with breast carcinoma liver metastases (BCLM). Methods: From January 2012 to December 2019, HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 19 patients with BCLM. All patients received systemic chemotherapy and HAI gemcitabine plus floxuridine (FUDR). Methods: The overall response rate (ORR) of intrahepatic lesions was 73.7%, including 2 patients (10.5%) with complete remission (CR) and 12 patients (63.2%) with partial remission (PR). Additionally, we found that young patients (age < 55 years) had a higher ORR than the older (100% vs 44.4%, P = .011). The median overall survival (mOS) was 13.1 months. Kaplan-Meier survival curves demonstrated that the mOS was not significantly different between patients with < 9 intrahepatic lesions and those with ≥ 9 lesions (13.7 months vs 10.9 months, P = .225). The mOS was 14.3 and 10.6 months for patients without extrahepatic metastases and with extrahepatic metastases, respectively ( P = .016). None of the patients had grade 4 toxicity. The grade 3 toxicities included leucopenia, neutropenia and diarrhea. Conclusions: HAI gemcitabine plus FUDR combined with systemic chemotherapy is effective in achieving a high local response and prolonging mOS for patients with BCLM and is associated with a relatively low rate of toxicity.

scholarly journals Hepatic artery infusion pump for nasopharyngeal carcinoma with liver metastasis

2019 ◽  
Vol 37 (2) ◽  
pp. 333-339
Author(s):  
Changli Peng ◽  
Chunhui Zhou ◽  
Gang Li ◽  
Haiping Li ◽  
Liangrong Shi
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Liver Metastases ◽  
Hepatic Artery ◽  
Infusion Pump ◽  
Objective Response ◽  
Complete Response ◽  
Hepatic Artery Infusion ◽  
Significant Difference ◽  
Extrahepatic Metastases ◽  
Grade 3

AbstractTo evaluate the benefits and risks of hepatic artery infusion (HAI) gemcitabine and floxuridine (FUDR) in patients with nasopharyngeal carcinoma liver metastases. HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 16 patients with unresectable nasopharyngeal carcinoma liver metastases. HAI gemcitabine and FUDR in combination with radiotherapy and systemic chemotherapy were delivered. Disease control rate (DCR) of intrahepatic lesions is 100%, objective response rate (ORR) of intrahepatic lesions is 87.5%, including 4 patients (25%) with complete response (CR), 10 patients (62.5%) with partial response (PR) and 2 patients (12.5%) with stable disease (SD). The median overall survival (mOS) was 30 months. There was no significant difference between patients with < 9 intrahepatic lesions and patients with ≥ 9 intrahepatic lesions (31 months vs. 24 months, P = 0.562). Patients without extrahepatic metastases has longer survival than patients with extrahepatic metastases (31 months vs. 17 months, P = 0.005). In all 72 cycles of HAI, the main grade 3/4 toxicities related to HAI include: leukopenia occur in 8 cycles (11.1%), thrombocytopenia in 5 cycles (6.9%), AST/ALT elevation in 12 cycles (16.7). Catheter related complications occurred in 2 patients (12.5%). HAI gemcitabine and FUDR is effective to improve DCR of intrahepatic lesions and prolong mOS for patients with nasopharyngeal carcinoma liver metastases, and is associated with a relative low rate of toxicity.

Hepatic resection of initially unresectable liver metastases from colorectal cancer after hepatic arterial infusion of oxaliplatin and systemic 5-fluorouracil and leucovorin

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15015-e15015
Author(s):  
D. Goere ◽  
I. Dsehais ◽  
T. de Baere ◽  
V. Boige ◽  
D. Malka ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Disease Free Survival ◽  
Hepatic Arterial Infusion ◽  
Morbidity Rate ◽  
Hepatic Artery Infusion ◽  
Arterial Infusion ◽  
Technical Problems ◽  
Hepatic Recurrence

e15015 Background: About 80% of patients (pts) presenting colorectal liver metastases (CRLM) are initially unresectable. A subgroup will become eligible for surgery after chemotherapy administration. Efficacy of hepatic arterial infusion (HAI) of oxaliplatin with systemic 5-Fluorouracil and leucovorin (LV5FU2) in with unresectable CRLM was previously demonstrated. This study was performed to evaluate the resection rate of pts with initially unresectable CRLM after oxaliplatin HAI and systemic LV5FU2. Methods: Patients treated in our hospital with oxaliplatin HAI and systemic LV5FU2 for unresectable CRLM from May 1999 to May 2007 were analyzed. Inclusion criteria were : unresectable CRLM, no extensive extrahepatic disease, HAI performed in our hospital, minimal follow up of 24 months. Eighty-seven pts were selected from a prospective database Results: Hepatic arterial infusion was delivered after previous systemic chemotherapy failure in 69 pts (80%). Main criterion for unresectability was massive liver involvement (80%). CRLM were synchronous and bilateral in respectively 85% and 90% of pts. The median number of oxaliplatin HAI cycles was 8 (0- 25). Thirty-one pts experienced technical problems with the arterial catheter, which was responsible for HAI withdrawal in seven. A total of 23 pts (26.4%) were operated, leading to resection and/or radiofrequency ablation of CRLM in 21 pts. No post-operative mortality was observed and the morbidity rate was 30%. The 3-year overall survival for patients operated was 72.5% versus 12% for non operated pts (p<0.0001). After a median follow-up of 75 months [24–118], intra-hepatic recurrence occurred in 10 pts. Conclusions: Hepatic artery infusion of oxaliplatin and systemic LV5FU2 increase the resectability rate in pts with advance CRLM even after previous systemic chemotherapy failure. Future studies combining oxaliplatin HAI and recent IV chemotherapy are needing to achieve an increase disease-free survival. No significant financial relationships to disclose.

scholarly journals Conversion to Resectability Using Hepatic Artery Infusion Plus Systemic Chemotherapy for the Treatment of Unresectable Liver Metastases From Colorectal Carcinoma

2009 ◽  
Vol 27 (21) ◽  
pp. 3465-3471 ◽  
Author(s):  
Nancy E. Kemeny ◽  
Fidel D. Huitzil Melendez ◽  
Marinela Capanu ◽  
Philip B. Paty ◽  
Yuman Fong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Hepatic Metastases ◽  
Hepatic Arterial Infusion ◽  
Hepatic Artery Infusion ◽  
Baseline Variable ◽  
Unresectable Liver Metastases ◽  
Previously Treated ◽  
Additional Value

Purpose To determine the conversion to resectability in patients with unresectable liver metastases from colorectal cancer treated with hepatic arterial infusion (HAI) plus systemic oxaliplatin and irinotecan (CPT-11). Patients and Methods Forty-nine patients with unresectable liver metastases (53% previously treated with chemotherapy) were enrolled onto a phase I protocol with HAI floxuridine and dexamethasone plus systemic chemotherapy with oxaliplatin and irinotecan. Results Ninety-two percent of the 49 patients had complete (8%) or partial (84%) response, and 23 (47%) of the 49 patients were able to undergo resection in a group of patients with extensive disease (73% with > five liver lesions, 98% with bilobar disease, 86% with ≥ six segments involved). For chemotherapy-naïve and previously treated patients, the median survival from the start of HAI therapy was 50.8 and 35 months, respectively. The only baseline variable significantly associated with a higher resection rate was female sex. Variables reflecting extensive anatomic disease, such as number of lesions or number of vessels involved, were not significantly associated with the probability of resection. Conclusion The combination of regional HAI floxuridine/dexamethasone and systemic oxaliplatin and irinotecan is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, demonstrating a 47% conversion to resection (57% in chemotherapy-naïve patients). Future randomized trials should compare HAI plus systemic chemotherapy with systemic therapy alone to assess the additional value of HAI therapy in converting patients with hepatic metastases to resectability.

scholarly journals Combined Systemic and Hepatic Artery Infusion Pump Chemo-Therapy as a Liver-Directed Therapy for Colorectal Liver Metastasis-Review of Literature and Case Discussion

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1283
Author(s):  
Salman Chaudhry ◽  
Ryan C. Fields ◽  
Patrick M. Grierson ◽  
Kian-Huat Lim
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Disease Control ◽  
Hepatic Artery ◽  
Systemic Chemotherapy ◽  
Infusion Pump ◽  
Colorectal Metastases ◽  
Hepatic Artery Infusion ◽  
Systemic Treatments

Colorectal cancer (CRC) is the third most prevalent malignancy and the second most common cause of death in the US. Liver is the most common site of colorectal metastases. About 13% of patients with colorectal cancer have liver metastasis on initial presentation and 50% develop them during the disease course. Although systemic chemotherapy and immunotherapy are the mainstay treatment for patients with metastatic disease, for selected patients with predominant liver metastasis, liver-directed approaches may provide prolonged disease control when combined with systemic treatments. Hepatic artery infusion pump (HAIP) chemotherapy is an approach which allows direct infusion of chemotherapeutic into the liver and is especially useful in the setting of multifocal liver metastases. When combined with systemic chemotherapy, HAIP improves the response rate, provides more durable disease control, and in some patients leads to successful resection. To ensure safety, use of HAIP requires multidisciplinary collaboration between interventional radiologists, medical oncologists, hepatobiliary surgeons and treatment nurses. Here, we review the benefits and potential risks with this approach and provide our single institution experience on two CRC patients successfully treated with HAIP in combination with systemic chemotherapy. We provide our recommendations in adopting this technique in the current era for patient with colorectal liver metastases.

scholarly journals Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands

2019 ◽  
Vol 26 (13) ◽  
pp. 4599-4607 ◽  
Author(s):  
Florian E. Buisman ◽  
Dirk J. Grünhagen ◽  
Marjolein Y. V. Homs ◽  
Cecile Grootscholten ◽  
Wills F. Filipe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
The Netherlands ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Infusion Pump ◽  
Hepatic Arterial Infusion ◽  
Arterial Infusion ◽  
Arterial Bleeding ◽  
Pump Implantation ◽  
Grade Iii

Abstract Background The 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs. Study Design A phase II study was performed in two centers in The Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, grade III or higher) and feasibility by the successful administration of the first cycle of HAIP chemotherapy. Results A total of 20 patients, with a median age of 57 years (interquartile range [IQR] 51–64) were included. Grade III or higher HAIP-related postoperative complications were found in two patients (10%), both of whom had a reoperation (without laparotomy) to replace a pump with a slow flow rate or to reposition a flipped pump. No arterial bleeding, arterial dissection, arterial thrombosis, extrahepatic perfusion, pump pocket hematoma, or pump pocket infections were found within 90 days after surgery. After a median of 43 days (IQR 29–52) following surgery, all patients received the first dose of HAIP chemotherapy, which was completed uneventfully in all patients. Conclusion Pump implantation is safe, and administration of HAIP chemotherapy is feasible, in patients with resectable CRLMs, after training of a dedicated multidisciplinary team.

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