title: Outcome analysis of a decade-long experience of isolated hepatic perfusion for unresectable liver metastases at a single institution.
abstract: OBJECTIVE
  To evaluate outcomes of isolated hepatic perfusion (IHP) on isolated liver metastases (LMs).
  
  
  BACKGROUND
  Isolated unresectable LMs are often the main determinant of overall survival (OS) for colorectal cancer (CRC) and other solid malignancies. We hypothesized that IHP can be performed safely and yield impressive responses for a variety of solid tumor pathology, using different perfusion agents.
  
  
  METHODS
  Retrospective review of a prospectively collected database of patients undergoing IHP for unresectable solid tumor LM.
  
  
  RESULTS
  Between 2003 and 2012, IHP was completed in 91 patients. Primary tumor pathology was CRC = 54, non-CRC = 37 (ocular/cutaneous melanoma = 32, cholangiocarcinoma = 3, appendiceal = 1, and breast = 1). IHP employed Melphalan (n = 69) (CRC = 32, non-CRC = 37), Oxaliplatin (n = 10) (CRC), or Oxaliplatin + 5FU (n = 12) (CRC). Hepatic arterial infusion (HAI) pumps were placed in all CRC patients. There were 3(3.3%) perioperative deaths. Response rates for CRC, melanoma, and cholangiocarcinoma were 68.2%, 57.1%, and 100% respectively. Response rates for CRC patients using 5FU + Oxaliplatin, Oxaliplatin, or Melphalan were 83.3%, 66.7%, and 60.9%, respectively. Median OS for the CRC patients (from IHP date) was 23 months (95% confidence interval: 15-28 months). On univariate analysis, receipt of HAI-FUDR (floxuridine) within 1 year of IHP was the only factor associated with improved OS (P = 0.043) in CRC patients.
  
  
  CONCLUSIONS
  IHP results in excellent response rates for patients with unresectable liver metastasis from solid tumors. Improved local control for CRC patients undergoing IHP-HAI may improve survival.
authors.affiliation: *Division of Surgical Oncology, Koch Regional Perfusion Center and †Department of Psychiatry, University of Pittsburgh Medical Center ‡Biostatistics Facility, University of Pittsburgh Cancer Institute, PA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Magge
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: Diana E
authors.initials: DE
authors.lastname: Cunningham
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steel
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.forename: Heather L
authors.initials: HL
authors.lastname: Jones
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents