Isolated hepatic perfusion with high-dose melphalan for the treatment of colorectal metastasis confined to the liver.

Abstract

Isolated hepatic perfusion (IHP) involves complete vascular isolation of the liver to allow treatment with doses that would be toxic if delivered systemically. A phase II study of IHP in patients with colorectal metastases confined to the liver was performed. Seventy-three patients with irresectable colorectal metastases underwent IHP with high-dose melphalan (200 mg) for 1 h. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria and tumour response was assessed according to World Health Organization criteria. Seventy-one patients were perfused according to the protocol. Four patients died within 30 days after IHP, resulting in an operative mortality rate of 5.6 per cent. Sixteen patients (22.5 per cent) experienced grade 3-4 hepatotoxicity 1 week after IHP, which was transient and resolved within 3 months in all patients. The tumour response rate (complete or partial remission) was 59 per cent. Median time to progression was 7.7 (range 2.3-31.4) months. Overall median survival after IHP was 28.8 months with a 3-year survival rate of 37 per cent. IHP for irresectable colorectal metastases confined to the liver resulted in good response rates and long-term survival in a selected group of patients.