Stop-flow perfusion with mitomycin-C as locoregional approach in the treatment of large-unresectable liver metastases.
BACKGROUND
New treatments are being investigated in patients with multiple or unresectable liver metastases, usually characterized by poor prognosis. Based on the predominant arterial blood supply of hepatic neoplasms, liver transarterial chemoembolization administers cytotoxic drugs in combination with the ischemic effect due to vascular occlusion. Mitomycin-C (MMC) is characterized by a high liver extraction rate and is potentiated by a hypoxic environment.


METHODS
This technique is performed by inducing a stop-flow of the hepatic artery, obtained by the placement of a balloon-catheter and followed by the infusion of MMC; in addition, in order to prevent iatrogenic lesions of the vascular wall, caused by the inflation of the balloon-catheter, a vascular stent is placed at the beginning of the procedure.


RESULTS
Thirty-one patients with liver metastases from various solid tumors were treated, while 47 sessions of treatment were performed. Toxicity was moderate; three cases of iatrogenic obstruction of the hepatic artery were observed, thus precluding further treatment.


CONCLUSIONS
The feasibility and the good tolerability of this procedure make it an interesting option in the therapeutical strategy for patients with advanced metastatic liver disease, as well as in combination with systemic chemotherapy, ablative and cytoreductive treatments and/or free-flow liver perfusions with anticancer drugs.
Gadaleta
C
C
Interventional Radiology Operative Unit, Oncology Institute, Bari, Italy. c.gadaleta@infinito.it
Catino
A
A
Mattioli
V
V
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000098:blood supply / Q000556:secondary* / Q000628:therapy*; D016685:Mitomycin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin