Chemosaturation with Percutaneous Hepatic Perfusions of Melphalan for Hepatic Metastases: Experience from Two European Centers
| Autor: | Gösta Lotz, Jan-Erik Scholtz, F. Schmitt, Franco Orsi, Stephan Zangos, S. Paetzold, Pier Francesco Ferrucci, Joerg Trojan, T. J. Vogl |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Melphalan medicine.medical_specialty medicine.medical_treatment Percutaneous hepatic perfusion Hemofiltration Humans Medicine Radiology Nuclear Medicine and imaging Vaginal bleeding Retroperitoneal hemorrhage Aged Chemotherapy Dose-Response Relationship Drug business.industry Liver Neoplasms Equipment Design Venous blood Middle Aged medicine.disease Magnetic Resonance Imaging Pancytopenia Surgery Europe Chemotherapy Cancer Regional Perfusion Positron-Emission Tomography Female medicine.symptom Tomography X-Ray Computed business Filtration Follow-Up Studies medicine.drug |
| Zdroj: | RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 186:937-944 |
| ISSN: | 1438-9010 1438-9029 |
| DOI: | 10.1055/s-0034-1366081 |
| Popis: | Purpose: 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. Materials and 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. Conclusion: 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. Citation Format: • Vogl TJ, Zangos S, Scholtz JE et al. Chemosaturation with Percutaneous Hepatic Perfusions of Melphalan for Hepatic Metastases: Experience from Two European Centers. Fortschr Rontgenstr 2014; 186: 937 – 944 |
| Databáze: | OpenAIRE |
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