Isolated Hepatic Perfusion with Extracorporeal Oxygenation Using Hyperthermia TNFα and Melphalan: Swedish Experience

  • L. Hafström
  • P. Naredi
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 147)


A phase I trial was performed to determine the toxicity and efficacy of isolated hepatic perfusion with tumour necrosis factorα (TNF) and melphalan (Alkeran) under mild hyperthermic conditions. Eleven patients with unresectable metastatic malignancies in the liver (malignant melanoma, leiomyosarcoma, colorectal cancer) underwent the procedure. Compared to our earlier experience with melphalan and cis-platinum under hyperthermic conditions (41.7 °C), this phase I study with TNF 30–200 μg and melphalan 0.5 mg/kg body weight under 39 °C hyperthermia neither improved the response rate nor decreased the serious adverse effects. Two patients died within the first postoperative month owing to coagulopathy or multiple organ failure. Five patients were reoperated owing to postoperative bleeding. Three of six patients with liver metastases from malignant melanoma or leiomyosarcoma and none of five patients with liver metastases from colorectal cancer showed a partial response.


Portal Vein Liver Metastasis Liver Perfusion Isolate Limb Perfusion Caval Vein 
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  1. Aigner KR, Walther H, Tonn J, Wenzl A, Hechtel R, Merker G, Schwemmle K (1983) First experimental and clinical results of isolated hepatic perfusion with cytotoxics in metastases from colorectal primary. Recent Results Cancer Res 86: 99–102PubMedGoogle Scholar
  2. Aigner KR, Walther H, Link KH (1988) Isolated liver perfusion with MMC/5-Fu: surgical technique, pharmacokinetics, clinical results. Contrib Oncol 29: 229–246Google Scholar
  3. Ausman RK (1961) Development of a technic for isolated perfusion of the liver. NY State J Med 61: 3993–3997Google Scholar
  4. Ausman RK, Aust JB (1960) Isolated perfusion of the liver with HN2. Surg Forum 10: 77PubMedGoogle Scholar
  5. Aust JB, Ausman RK (1960) The technique of liver perfusion. Cancer Chemother Rep 10: 23–33PubMedGoogle Scholar
  6. Hafstrom L, Mattson J (1993) Regional chemotherapy for malignant melanoma. Cancer Treat Rev 19: 17–28PubMedCrossRefGoogle Scholar
  7. Hafström L, Holmberg SB, Naredi P, Lindnér PG, Bengtsson A, Tidebrant G, Scherstén T (1994 a) Isolated hyperthermic liver perfusion with chemotherapy for liver malignancy. Surg Oncol 3: 103–108Google Scholar
  8. Hafström L, Holmberg SB, Lindnér PL, Naredi P, Asztely M, Bengtsson A, Nielsen HK, Scherstén T (1994 b) Isolated regional liver perfusion with tumour necrosis factor-alpha followed by hyperthermic melphalan perfusion. Reg Cancer Treat 7: 172–176Google Scholar
  9. Healey JE (1960) The technique of liver perfusion. Cancer Chemother Rep 10: 24Google Scholar
  10. Healey JE, Smith JL, Clark RL, Stehlin JS, White EG (1961) Hepatic tissue tolerance to thio-TEPA administered by the isolation-perfusion technique. J Surg Res 1: 111–116PubMedCrossRefGoogle Scholar
  11. Jaskowiak NT, Alexander HR, Bartlett DL, Turner EM, Tsigos C, Papanicolaou D, Chrousos GP, Fraker DL (1996) Secondary cytokine production and endocrine effects after high dose intravascular TNF. In: Fraker DL, Jacobsen SE (eds) TNF and related cytokines: clinical utility and biology of action. Cambridge Symposia, Hilton Head Island, South Carolina, p 8Google Scholar
  12. Lienard D, Lejeune FJ, Ewalenko P (1992) In transit metastases of malignant melanoma treated by high dose rTNF-alpha in combination with interferon-gamma and melphalan in isolation perfusion. World J Surg 16: 234–240PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1998

Authors and Affiliations

  • L. Hafström
    • 1
  • P. Naredi
    • 2
  1. 1.Department of SurgeryUniversity HospitalUmeåSweden
  2. 2.Department SurgerySahlgrenska University HospitalGothenburgSweden

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