title: Isolated hepatic perfusion for the treatment of patients with advanced liver metastases from pancreatic and gastrointestinal neuroendocrine neoplasms.
abstract: BACKGROUND
  We report results of using isolated hepatic perfusion (IHP) in patients with advanced progressive liver metastases (LM) from pancreatic and gastrointestinal neuroendocrine neoplasms (NENs).
  
  
  METHODS
  Thirteen patients with LM from NENs (mean percent hepatic replacement, 30; range, 10-60) were treated with a 1-hour hyperthermic IHP via a laparotomy with the use of 1.5 or 2.0 mg/kg melphalan and/or 1 mg tumor necrosis factor. An oxygenated extracorporeal circuit with inflow through the gastroduodenal artery and common hepatic artery, and outflow to a segment of the inferior vena cava was used. Portal flow and inferior vena cava flow were shunted to the axillary vein. Radiographic response, recurrence pattern, and survival were assessed.
  
  
  RESULTS
  Mean operative time was 9 hours (8-11 hours), and a median hospital stay was 10 days (6-64 days). Fifty percent of evaluable patients had a radiographic partial response in the liver (mean duration, 15 months; range, 6-26 months; 2 ongoing). Four had a marginal response (25%-49% reduction in the neoplasm). The median, hepatic, progression-free survival was 7 months (range, 3-27 months). The median actuarial survival was 48 months including 1 treatment mortality (median follow-up, 23 months).
  
  
  CONCLUSIONS
  For patients with advanced LM from NENs, IHP provides a reasonable response rate and duration with acceptable morbidity; continued clinical evaluation is important.
authors.affiliation: Surgical Metabolism Section, Surgery Branch, National Cancer Institute/NIH, 10 Center Drive, Building 10, Room 2B07, Bethesda, MD 20892, USA.
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Grover
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Cynthia
authors.initials: C
authors.lastname: Helsabeck
authors.forename: Tatiana
authors.initials: T
authors.lastname: Beresnev
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D006979:Hyperthermia, Induced; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D017599:Neuroectodermal Tumors / Q000556:secondary* / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan