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CardioVascular and Interventional Radiology

, Volume 35, Issue 6, pp 1480–1487 | Cite as

Chemosaturation with Percutaneous Hepatic Perfusion for Unresectable Isolated Hepatic Metastases from Sarcoma

  • Jeremiah L. Deneve
  • Junsung Choi
  • Ricardo J. Gonzalez
  • Anthony P. Conley
  • Steven Stewart
  • Dale Han
  • Philip Werner
  • Tariq A. Chaudhry
  • Jonathan S. Zager
Technical Note

Abstract

Purpose

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).

Methods

We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver.

Results

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.

Conclusion

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.

Keywords

Chemosaturation Liver tumors Metastasis Percutaneous hepatic perfusion Sarcoma 

Notes

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.

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Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Jeremiah L. Deneve
    • 1
  • Junsung Choi
    • 2
  • Ricardo J. Gonzalez
    • 1
  • Anthony P. Conley
    • 1
  • Steven Stewart
    • 1
  • Dale Han
    • 1
  • Philip Werner
    • 3
  • Tariq A. Chaudhry
    • 3
  • Jonathan S. Zager
    • 1
  1. 1.Department of Cutaneous and Sarcoma OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of Interventional RadiologyMoffitt Cancer CenterTampaUSA
  3. 3.Department of AnesthesiaMoffitt Cancer CenterTampaUSA

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