Chemosaturation with percutaneous hepatic perfusion for unresectable isolated hepatic metastases from sarcoma

Jeremiah Deneve, Junsung Choi, Ricardo J. Gonzalez, Anthony P. Conley, Steven Stewart, Dale Han, Philip Werner, Tariq A. Chaudhry, Jonathan S. Zager

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP). Methods: We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver. Results: A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis. Conclusion: CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.

Original languageEnglish (US)
Pages (from-to)1480-1487
Number of pages8
JournalCardiovascular and Interventional Radiology
Volume35
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

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Sarcoma
Perfusion
Neoplasm Metastasis
Liver
Disease-Free Survival
Leiomyosarcoma
Compassionate Use Trials
Therapeutics
Melphalan
Poisons
Neutropenia

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Chemosaturation with percutaneous hepatic perfusion for unresectable isolated hepatic metastases from sarcoma. / Deneve, Jeremiah; Choi, Junsung; Gonzalez, Ricardo J.; Conley, Anthony P.; Stewart, Steven; Han, Dale; Werner, Philip; Chaudhry, Tariq A.; Zager, Jonathan S.

In: Cardiovascular and Interventional Radiology, Vol. 35, No. 6, 01.12.2012, p. 1480-1487.

Research output: Contribution to journalArticle

Deneve, J, Choi, J, Gonzalez, RJ, Conley, AP, Stewart, S, Han, D, Werner, P, Chaudhry, TA & Zager, JS 2012, 'Chemosaturation with percutaneous hepatic perfusion for unresectable isolated hepatic metastases from sarcoma', Cardiovascular and Interventional Radiology, vol. 35, no. 6, pp. 1480-1487. https://doi.org/10.1007/s00270-012-0425-x
Deneve, Jeremiah ; Choi, Junsung ; Gonzalez, Ricardo J. ; Conley, Anthony P. ; Stewart, Steven ; Han, Dale ; Werner, Philip ; Chaudhry, Tariq A. ; Zager, Jonathan S. / Chemosaturation with percutaneous hepatic perfusion for unresectable isolated hepatic metastases from sarcoma. In: Cardiovascular and Interventional Radiology. 2012 ; Vol. 35, No. 6. pp. 1480-1487.
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AU - Choi, Junsung

AU - Gonzalez, Ricardo J.

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AU - Stewart, Steven

AU - Han, Dale

AU - Werner, Philip

AU - Chaudhry, Tariq A.

AU - Zager, Jonathan S.

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N2 - Purpose: Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP). Methods: We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver. Results: A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis. Conclusion: CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.

AB - Purpose: Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP). Methods: We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver. Results: A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis. Conclusion: CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.

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