Initiation of Chemosaturation With Percutaneous Hepatic Perfusion Program in Interventional Radiology Department

Osman Öcal; Gonca Eldem; Ayse H Karagoz; Saadettin Kılıçkap; Suayib Yalcin; Ferhun Balkanci; Bora Peynircioglu

doi:10.7759/cureus.17880

Initiation of Chemosaturation With Percutaneous Hepatic Perfusion Program in Interventional Radiology Department

Cureus. 2021 Sep 10;13(9):e17880. doi: 10.7759/cureus.17880. eCollection 2021 Sep.

Authors

Osman Öcal¹, Gonca Eldem¹, Ayse H Karagoz², Saadettin Kılıçkap³, Suayib Yalcin³, Ferhun Balkanci¹, Bora Peynircioglu¹

Affiliations

¹ Radiology, Hacettepe University, Ankara, TUR.
² Anesthesiology and Reanimation, Hacettepe University, Ankara, TUR.
³ Medical Oncology, Hacettepe University, Ankara, TUR.

Abstract

Objectives Chemosaturation with percutaneous hepatic perfusion (PHP) is a relatively new minimally-invasive liver-directed therapy, which aims to deliver high-dose chemotherapy into the liver with low systemic side effects. Initial studies showed promising results, especially in the treatment of metastatic uveal melanoma. But unfamiliarity of the interventional radiologists prevents its widespread implantation in clinical routine. This study aimed to outline how to initiate a PHP program and report initial results. Methods We retrospectively reviewed all patients who underwent chemosaturation with PHP in our institution between March 2016 and February 2017 and their follow-up results till October 2018. Patient demographics, procedural characteristics, clinical and imaging results, and complications were evaluated. Additionally, modifications regarding infrastructure and procedure techniques were described. Results A total of three patients (two females and one male) with a mean age of 59 underwent six PHP procedures. The primary disease was colorectal carcinoma in one patient and uveal melanoma in two patients. The technical success rate was 100% and the mean melphalan dose was 190.8 mg. No procedural death was observed. Patients were hospitalized for a mean of 3.3 days after procedures. Grade 3 and 4 complications were seen after 50% and 33.3% of procedures, respectively. Two patients showed partial response and the other patient showed stable disease after procedures. Mean hepatic progression-free survival was 10.8 months. Overall survival from the first procedure was 14.8 months in our cohort. Conclusion Our results show that chemosaturation with PHP offers a promising minimally invasive treatment option in patients with unresectable liver metastases. The technical challenges of PHP can be easily handled by an experienced interventional radiology (IR) team. It is a relatively safe procedure and its toxicities are usually hematological and can be manageable with close surveillance and appropriate medical therapies.

Keywords: chemosaturation; colorectal cancer; liver; melanoma; percutaneous hepatic perfusion.