title: Isolated hepatic melphalan perfusion of colorectal liver metastases: outcome and prognostic factors in 154 patients.
abstract: BACKGROUND
  The aim of this study was to identify prognostic factors for local and systemic failure after isolated hepatic perfusion (IHP) with 200 mg melphalan in patients with colorectal liver metastases.
  
  
  METHODS
  Hundred and fifty-four patients were selected for IHP and underwent laparotomy. Patients were monitored for response, toxicity and survival. Univariate and multivariate analyses were carried out to identify prognostic factors for hepatic response and progression-free and overall survival.
  
  
  RESULTS
  Hepatic response rate was 50% with a median progression-free and overall survival of, respectively, 7.4 and 24.8 months. In multivariate analyses, absence of ability to perfuse through the hepatic artery (P = 0.003), severe postoperative complications (P = 0.048) and >10 liver metastases (P = 0.006) adversely influenced overall survival and no adjuvant chemotherapy adversely influenced progression-free survival.
  
  
  CONCLUSIONS
  This is the first study to report prognostic factors for survival after IHP. Possibly, overall and disease-free survival can increase if preoperative screening is improved. In future studies on IHP, adjuvant chemotherapy should be considered.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands. l.b.j.van_iersel@lumc.nl
authors.forename: L B J
authors.initials: LB
authors.lastname: van Iersel
authors.forename: H
authors.initials: H
authors.lastname: Gelderblom
authors.forename: A L
authors.initials: AL
authors.lastname: Vahrmeijer
authors.forename: E L
authors.initials: EL
authors.lastname: van Persijn van Meerten
authors.forename: F G J
authors.initials: FG
authors.lastname: Tijl
authors.forename: H
authors.initials: H
authors.lastname: Putter
authors.forename: H H
authors.initials: HH
authors.lastname: Hartgrink
authors.forename: P J K
authors.initials: PJ
authors.lastname: Kuppen
authors.forename: J W R
authors.initials: JW
authors.lastname: Nortier
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan