Hepatic arterial port systems for treatment of liver metastases: factors affecting patency and adverse events.
OBJECTIVE
To assess the outcome of interventional hepatic arterial port placement in a prospective phase II trial.


METHODS
One-hundred five consecutive patients were included in this study. Primary endpoint was port patency; secondary endpoints were complications, toxicity, response, and progression free and overall survival. Seventy-eight patients presented with liver metastasis only, 6 patients had additional minor extrahepatic disease, and 21 patients had no evidence of disease after liver resection, laser-induced thermotherapy, or computed tomography (CT)-guided interstitial brachytherapy of liver metastasis. Exclusive access route was the femoral artery. Subgroup analysis compared either 4-F catheters (n = 58) to 2.2-F (n = 33) and 2.7-F (n = 20) microcatheters or different strategies in anatomic variants of the celiac branch: neglect (n = 10) or embolization of minor hepatic feeders (n = 11), splenic arterial port (n = 8), double port (n = 7).


RESULTS
Technical success was 99%. Assisted port patency after 6 months was 93%. Complications demanding port revisions were significantly lower in patients receiving 4-F versus 2.2-F and 2.7-F systems (P <.001), with disconnection as the major problem with use of microcatheters. Hepatic artery thrombosis occurred in 10 patients (9%), with successful lysis in two patients. With use of 4-F and 2.2-F catheters, there was no difference with respect to catheter occlusion or hepatic thrombosis. No differences were noted in complications or outcome applying four different strategies in celiac branch variants. In a subgroup of patients receiving folinic acid/5-fluorouracil (170 mg/600 mg; 10% dose escalation per cycle) for 5 days every 4 weeks only 15% experienced Grade 3 toxicity. Patients with liver metastasis and salvage therapy demonstrated progression-free survival of 63% after 6 months and a median survival of 16 months.


CONCLUSIONS
Interventional placement of hepatic arterial port systems may overcome frequent hepatic arterial chemotherapy failures as encountered in all published major trials on hepatic arterial infusion.
Department of Radiology, Charité Campus Virchow-Klinikum, Humboldt-University, Augustenburgerplatz 1, 13353 Berlin, Germany. jens.ricke@charite.de
Jens
J
Ricke
Bert
B
Hildebrandt
Alexandra
A
Miersch
Annett
A
Nicolaou
Guesjal
G
Warschewske
Ulf
U
Teichgräber
Enrique
E
Lopez Hänninen
Hanno
H
Riess
Roland
R
Felix
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D005472:Fluorouracil