Isolated hepatic perfusion with 200 mg melphalan for advanced noncolorectal liver metastases.
OBJECTIVE
The liver is one of the most common sites for metastatic solid tumors. If the liver is the only site of metastatic disease, regional treatment options can offer the benefit of high local exposure with limited systemic toxicity, especially for patients without (further) systemic treatment options. We report the results of our experience with isolated hepatic perfusion (IHP) in patients with isolated liver metastases from a variety of primary tumors.


METHODS
Nineteen patients with isolated unresectable liver metastases from a variety of tumors (13 uveal melanomas, 2 neuroendocrine carcinomas, 2 gastrointestinal stromal tumors, 1 hepatocellular carcinoma, and 1 high-grade sarcoma) were treated with a 60-min IHP using 200 mg melphalan. Patients were monitored for toxicity, response according to response evaluation criteria in solid tumors (RECIST) criteria, and survival.


RESULTS
One melanoma patient was not perfused due to insufficient isolation of the liver. There was no treatment-related mortality. Reversible grade 3 or 4 hepatoxicity occurred in 10 (56%) patients, while veno-occlusive disease occurred in 4 (22%) patients. Of the 12 uveal melanoma patients who were perfused, 4 (33%) patients had a partial hepatic response, 6 (50%) patients had stable hepatic disease, and 2 (17%) patients were immediately progressive. Median disease-free survival was 6.6 months with a median overall survival of 10.0 months. Fifty percent of other primary tumors showed at least partial remission, including one complete remission in a high-grade sarcoma patient.


CONCLUSIONS
IHP with melphalan shows activity in patients with liver metastases from a variety of primary tumors, but other or additional drugs may improve therapeutic outcome.
van Iersel
Liselot B J
LB
Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. l.b.j.van_iersel@lumc.nl
Hoekman
Ellen J
EJ
Gelderblom
Hans
H
Vahrmeijer
Alexander L
AL
van Persijn van Meerten
Els L
EL
Tijl
Fred G J
FG
Hartgrink
Henk H
HH
Kuppen
Peter J K
PJ
Nortier
Johan W R
JW
Tollenaar
Rob A E M
RA
van de Velde
Cornelis J H
CJ
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan