title: Hypoxic liver perfusion with mitomycin-C for treating multifocal metastases and unresectable primary tumours: a single-centre series of 42 patients.
abstract: OBJECTIVE
  The purpose of our study was to retrospectively evaluate the feasibility, toxicity and impact on overall (OS) and disease-free (DFS) survival of intra-arterial liver perfusion with mitomycin-C (MMC) [hypoxic liver perfusion with MMC (HLPM)] in patients with multifocal liver metastases or with unresectable primary liver tumours.
  
  
  METHODS
  Forty-two patients underwent 56 intra-arterial liver infusions with MMC between June 2001 and May 2009. The patients presented specific characteristics, i.e. they were all refractory to locoregional (LR) and/or systemic treatments. HLPM consists of selective catheterisation of the common hepatic artery, permanent occlusion of the gastroduodenal artery at its origin using metal coils, an inflated balloon catheter placement at the origin of the proper hepatic artery to block blood flow and induce hypoxia for around 10 min, MMC infusion and vascular-bed occlusion through injection of an absorbable haemostatic agent. During the procedure, the patients received anaesthesiological monitoring. Biochemical and morphological responses were evaluated, as were haematological, hepatic and systemic toxicity.
  
  
  RESULTS
  Patients were hospitalised for 10 days on average (range 7-15). Side effects were liver toxicity in all cases, acute pancreatitis in one case and liver failure in one case. Computed tomography performed at 30 days documented a partial response (PR) in 29%, stable disease (SD) in 45% and progressive disease (PD) in 26% of patients. The response lasted 4 months on average (range 3-6). Mean overall survival (OS) was 20 months for all patients, reaching 30 months in those with colorectal carcinoma.
  
  
  CONCLUSIONS
  The procedure is feasible, and treatmentrelated toxicity and mortality rates are acceptable. It may be considered a palliative treatment option in patients with advanced liver disease in centres with adequately experienced medical teams.
authors: UO Oncologia Medica, Ospedale San Giuseppe, Via San Vittore 12, 20123, Milano, Italy.
authors: A
authors: A
authors: Bagliani
authors: A
authors: A
authors: Baggiani
authors: A M
authors: AM
authors: Ierardi
authors: B
authors: B
authors: Caspani
authors: F
authors: F
authors: Motta
authors: D
authors: D
authors: Toniolo
authors: P
authors: P
authors: Belloni
authors: E
authors: E
authors: Setola
authors: E
authors: E
authors: Campagnoli
authors: S
authors: S
authors: Tempini
authors: R
authors: R
authors: Crocchiolo
authors: M
authors: M
authors: Bregni
authors: L
authors: L
authors: Belli
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015687:Cell Hypoxia; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007297:Inpatients; D007902:Length of Stay; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009362:Neoplasm Metastasis; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin