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.
KeywordsToxicity Catheter Heparin Oncol Sarcoma
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