Significance of duplex/colour Doppler sonography in hepatic arterial chemotherapy for patients with liver metastases from colorectal carcinoma.
OBJECTIVE
The aim of the study was to evaluate the importance of duplex/colour Doppler ultrasound in a protocol of hepatic regional chemotherapy, by measuring the blood flow in the hepatic artery, portal vein, hepatic veins, and inferior caval vein of patients with unresectable liver metastases from colorectal carcinoma.


METHODS
Thirty-nine consecutive subjects were selected for this study, including 21 patients who had unresectable histologically confirmed liver metastases from colorectal carcinoma (Group A), and 18 asymptomatic volunteers as normal controls (Group B). All subjects of Groups A and B were examined using duplex/colour Doppler sonography. After the ultrasound study, all patients of Group A were submitted to the administration of high dose mitomycin C into the hepatic artery, with concomitant detoxication of post-hepatic venous blood.


RESULTS
The mean value of the hepatic artery blood flow was significantly higher (P=0.0009) in liver metastases patients (361 ml/min, SEM=24 ml/min) than in normal controls (245 ml/min, SEM=20 ml/min). Also, the mean Doppler perfusion index was higher in liver metastases patients than in normal controls. For each patient of Group A, the total dose of mitomycin C to be infused was calculated based on the blood flow in the hepatic artery. In this way the concentration of mitomycin C in the hepatic artery was always greater than 3 microg/ml. The duration of detoxication was calculated based on the blood flow in the inferior caval vein. For two patients only, the blood flow was lower than 1000 ml/min, with the necessity to protract the duration of detoxication over 2 hours.


CONCLUSIONS
The measurement of the blood flow in hepatic vessels of patients with liver metastases seems to be very important in establishing the total dose of drug which has to be infused in hepatic arterial chemotherapy, and to determine the duration of concomitant detoxication of post-hepatic venous blood.
Guadagni
S
S
Department of Surgery, University of L'Aquila, Italy. guadagni@rdn.it
Pizzutilli
A
A
Mancini
E
E
Varrone
A
A
Palumbo
G
G
Amicucci
G
G
Perri
S
S
Deraco
M
M
Fiorentini
G
G
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008658:Inactivation, Metabolic; D007261:Infusions, Intra-Arterial / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011169:Portal Vein / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin