Isolated hypoxic hepatic perfusion (IHHP) using balloon catheter techniques: from laboratory to the clinic towards a percutaneous procedure.
OBJECTIVE
The success of and our extensive experience with TNF alpha-based isolated limb perfusions in patients with unresectable extremity soft tissue sarcomas made us explore the possibilities for a similar approach for the treatment of hepatic metastases. After experience with the classic surgical isolated hepatic perfusion in pigs and in patients, we concluded that the classic surgical approach was associated with serious drawbacks i.e., magnitude of the procedure with morbidity, lack of repeatability of the procedure, complexity and costs. These problems were addressed in a program aimed at developing a repeatable method of isolated perfusion of the liver with minimally invasive techniques.


METHODS
We validated the methodology of isolated hypoxic hepatic perfusion using balloon catheter techniques in pigs.


RESULTS
The excellent pharmacokinetic profile of the procedure, resulting in very high regional drug concentrations and negligible systemic drug concentrations, allowed us to move on to the clinic and start to study and further develop this method in a phase I-II study using the drug melphalan, in patients with irresectable hepatic metastases.


CONCLUSIONS
We aim to develop step by step a fully percutaneous approach for isolated hypoxic hepatic perfusion.
Department of Surgical Oncology, University Hospital Rotterdam-Den Hoed Cancer Center (UHR-DHCC), The Netherlands. eggermont@chih.azr.nl
A M
AM
Eggermont
M G
MG
van IJken
B
B
van Etten
J R
JR
van der Sijp
T L
TL
ten Hagen
T
T
Wiggers
M
M
Oudkerk
G
G
de Boeck
E A
EA
de Bruijn
D000368:Aged; D000818:Animals; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D002404:Catheterization; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013552:Swine
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan