Isolated Hepatic Perfusion with Extracorporeal Oxygenation Using Hyperthermia TNFα and Melphalan: Swedish Experience
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.
KeywordsPortal Vein Liver Metastasis Liver Perfusion Isolate Limb Perfusion Caval Vein
Unable to display preview. Download preview PDF.
- 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
- Ausman RK (1961) Development of a technic for isolated perfusion of the liver. NY State J Med 61: 3993–3997Google Scholar
- 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
- 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
- Healey JE (1960) The technique of liver perfusion. Cancer Chemother Rep 10: 24Google Scholar
- 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