Chemosaturation with percutaneous hepatic perfusion for unresectable isolated hepatic metastases from sarcoma.
OBJECTIVE
Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP).


METHODS
We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver.


RESULTS
A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis.


CONCLUSIONS
CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.
Department of Cutaneous and Sarcoma Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB4, 24012, Tampa, FL 33612, USA. Jeremiah.Deneve@Moffitt.org
Jeremiah L
JL
Deneve
Junsung
J
Choi
Ricardo J
RJ
Gonzalez
Anthony P
AP
Conley
Steven
S
Stewart
Dale
D
Han
Philip
P
Werner
Tariq A
TA
Chaudhry
Jonathan S
JS
Zager
D000279:Administration, Cutaneous; D000368:Aged; D000792:Angiography; D001706:Biopsy; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy* / Q000556:secondary*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D049268:Positron-Emission Tomography; D012811:Sigmoid Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed