title: Chemosaturation with percutaneous hepatic perfusions of melphalan for hepatic metastases: experience from two European centers.
abstract: OBJECTIVE
  Chemosaturation with percutaneous hepatic perfusion (PHP; Hepatic CHEMOSAT(®) Delivery System; Delcath Systems Inc, USA) is a minimally invasive, repeatable regional therapy for unresectable hepatic metastases. It uses a system of catheters and filters to isolate hepatic venous blood from the systemic circulation, allowing delivery of high-dose chemotherapy to the hepatic artery. Effluent hepatic venous blood is filtered before being returned to the systemic circulation, thereby reducing exposure to chemotherapy. We describe our experiences with chemosaturation-PHP at 2 European centers.
  
  
  METHODS
  14 patients presented unresectable hepatic metastases from solid tumors; 13 received 1 - 3 sessions of chemosaturation-PHP. Melphalan 2.0 (n = 1) or 3.0 (n = 12) mg/kg was given as a 30-minute infusion into the hepatic artery. 12 patients were evaluable for tumor response.
  
  
  RESULTS
  One complete (cholangiocarcinoma, n = 1) and 6 partial responses (ocular, n = 3 or cutaneous melanoma, n = 3) were observed, 5 patients had stable disease (ocular melanoma, n = 3; breast cancer, n = 1; gastric cancer, n = 1). Mild to moderate filter-related toxicity (i. e. thrombocytopenia, anemia) was observed immediately post-procedure. Grade 3/4 melphalan-related pancytopenia developed after 1 - 2 weeks. All hematological events were managed effectively with transfusions and/or other supportive measures. The new high-efficiency filter showed milder toxicity and faster recovery. In one case, chemosaturation-PHP was abandoned prematurely due to heparin-induced vaginal bleeding, and one patient died due to retroperitoneal hemorrhage from heparin anti-coagulation.
  
  
  CONCLUSIONS
  Chemosaturation-PHP for non-resectable liver metastases is a feasible treatment option when performed by an experienced multi-disciplinary team. It may be a promising regional therapy for patients with no effective treatment options.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt.
authors.forename: T J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt.
authors.forename: S
authors.initials: S
authors.lastname: Zangos
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt.
authors.forename: J E
authors.initials: JE
authors.lastname: Scholtz
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt.
authors.forename: F
authors.initials: F
authors.lastname: Schmitt
authors.affiliation: Department of Dermatology, Venerology and Allergology, University Hospital of Frankfurt.
authors.forename: S
authors.initials: S
authors.lastname: Paetzold
authors.affiliation: Department of Medicine I, University Hospital of Frankfurt.
authors.forename: J
authors.initials: J
authors.lastname: Trojan
authors.affiliation: Unit of Interventional Radiology, European Institute of Oncology, Milan.
authors.forename: F
authors.initials: F
authors.lastname: Orsi
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Frankfurt.
authors.forename: G
authors.initials: G
authors.lastname: Lotz
authors.affiliation: Translational Research on Melanoma, European Institute of Oncology, Milan.
authors.forename: P
authors.initials: P
authors.lastname: Ferrucci
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation*; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D005060:Europe; D005260:Female; D005374:Filtration / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D008558:Melphalan