Chemosaturation with Percutaneous Hepatic Perfusion for Unresectable Isolated Hepatic Metastases from Sarcoma
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Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP).
We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver.
A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis.
CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.
KeywordsChemosaturation Liver tumors Metastasis Percutaneous hepatic perfusion Sarcoma
Conflict of interest
S. Stewart and J. Choi are paid consultants for Delcath Systems Inc. J. S. Zager is a consultant for and member of the medical advisory board for Delcath Systems Inc. The other authors declare that they have no conflict of interest.
- 2.Van Glabbeke M, van Oosterom AT, Oosterhuis JW et al (1999) Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcoma: an analysis of 2,185 patients treated with anthracycline-containing first-line regimens—a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group study. J Clin Oncol 17:150–157PubMedGoogle Scholar
- 10.Pingpank JF, Hughes MS, Alexander HR et al (2010) A phase III random assignment trial comparing percutaneous hepatic perfusion with melphalan (PHP-mel) to standard of care for patients with hepatic metastases from metastatic ocular or cutaneous melanoma. J Clin Oncol 28(18 suppl):LBA8512Google Scholar
- 13.Hughes M, Royal RE, Alexander HR et al (2011) Chemosaturation with percutaneous hepatic perfusion (CS-PHP) using melphalan for unresectable neuroendocrine tumor liver metastases (MNET): NCT 00096083. Presented at European Multidisciplinary Cancer Congress, ECC-ESMO, Abstract 6621Google Scholar