Isolated Hyperthermic Hepatic Chemoperfusion in Patients with Colorectal Cancer and Isolated Non-Resectable Liver Metastases
The aim of the study was to evaluate the clinical efficacy of isolated hyperthermic hepatic chemoperfusion (IHHC) in patients with colorectal cancer and isolated non-resectable liver metastasis (M1c) resistant to systemic polychemotherapy (PCT). Materials and Methods. The study included 6 patients with colorectal cancer with isolated non-resectable liver metastatic lesions resistant to systemic PCT. The average age of patients was 59.3±3.4 years. Before the IHHC, all patients received 2 cycles or more of PCT that failed to prevent an increase in metastatic foci in the liver. The IHHC was performed using an artificial circulation device; the chemotherapeutic agents (melphalan in combination with TNF-α) were administered through the gastroduodenal artery. Blood from the retro-hepatic segment of the inferior vena cava was collected after the liver vessels were completely isolated and a parallel circulation shunt was established for returning the blood into the superior vena cava from the inferior vena cava and the portal vein. Results. In 3 patients with follow-up examinations at 3 and 6 months, a complete response (according to the mRECIST scores) was noted; in the other 3 patients, there was a partial response to the treatment. In patients with a complete response, the use of IHHC resulted in complete tumor pathomorphism confirmed by histology and spiral CT at 3 and 6 months after the procedure. Conclusion. IHHC with melphalan and TNF-α can be used for regional chemotherapy in patients with isolated non-resectable metastases resistant to systemic chemotherapy.