1
|
Marquardt S, Kirstein MM, Brüning R, Zeile M, Ferrucci PF, Prevoo W, Radeleff B, Trillaud H, Tselikas L, Vicente E, Wiggermann P, Manns MP, Vogel A, Wacker FK. Percutaneous hepatic perfusion (chemosaturation) with melphalan in patients with intrahepatic cholangiocarcinoma: European multicentre study on safety, short-term effects and survival. Eur Radiol 2018; 29:1882-1892. [PMID: 30255257 DOI: 10.1007/s00330-018-5729-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/02/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Cholangiocarcinoma is the second most common primary liver tumour with a poor overall prognosis. Percutaneous hepatic perfusion (PHP) is a directed therapy for primary and secondary liver malignancies, and its efficacy and safety have been shown in different entities. The purpose of this study was to prove the safety and efficacy of PHP in patients with unresectable intrahepatic cholangiocarcinoma (iCCA). PATIENTS AND METHODS We retrospectively reviewed data from 15 patients with unresectable iCCA treated with PHP in nine different hospitals throughout Europe. Overall response rates (ORR) were assessed according to response evaluation criteria in solid tumours (RECIST1.1). Overall survival (OS), progression-free survival (PFS) and hepatic PFS (hPFS) were analysed using the Kaplan-Meier estimation. Adverse events (AEs) and toxicity were evaluated. RESULTS Fifteen patients were treated with 26 PHPs. ORR was 20%, disease control was achieved in 53% after the first PHP. Median OS was 26.9 months from initial diagnosis and 7.6 months from first PHP. Median PFS and hPFS were 122 and 131 days, respectively. Patients with liver-only disease had a significantly longer median OS compared to patients with locoregional lymph node metastases (12.9 vs. 4.8 months, respectively; p < 0.01). Haematological toxicity was common, but manageable. No AEs of grade 3 or 4 occurred during the procedures. DISCUSSION PHP is a standardised and safe procedure that provides promising response rates and survival data in patients with iCCA, especially in non-metastatic disease. KEY POINTS • Percutaneous hepatic perfusion (PHP) offers an additional locoregional therapy strategy for the treatment of unresectable primary or secondary intrahepatic malignancies. • PHP is a standardised and safe procedure that provides promising response rates and survival data in patients with intrahepatic cholangiocarcinoma (iCCA), especially in non-metastatic disease. • Side effects seem to be tolerable and comparable to other systemic or local treatment strategies.
Collapse
Affiliation(s)
- Steffen Marquardt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Roland Brüning
- Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Martin Zeile
- Department of Radiology and Neuroradiology, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Warner Prevoo
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hervé Trillaud
- Department of Radiology, Bordeaux University Hospital Center, Bordeaux, France
| | - Lambros Tselikas
- Department of Radiology, Gustave Roussy Cancer Campus, Paris, France
| | - Emilio Vicente
- General Surgery Department, HM University Sanchinarro Hospital, Madrid, Spain
| | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| |
Collapse
|
2
|
Mouchli MA, Kerr SE, Roberts L. An Enlarging Metastatic Calcified Liver Lesion of an Occult Melanoma. Case Rep Oncol 2018; 11:388-391. [PMID: 30022941 PMCID: PMC6047565 DOI: 10.1159/000489555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 12/03/2022] Open
Abstract
Calcified liver lesions are caused by a wide variety of factors. The most common lesions are inflammatory liver lesions followed by benign and malignant neoplasms. Hemangioma, one of the most common benign hepatic neoplasm in adults, often contains calcifications, in up to 20% of cases secondary to fibrosis and thrombosis of blood vessels. These calcifications are typically large, coarse, and located in the center of the lesions. Liver metastases, the most common malignant lesions found in the noncirrhotic liver, may contain areas of calcification. Radiologists should be aware of morphologic imaging features of calcified liver lesions to help differentiate benign from malignant lesions. Liver biopsy should be offered when the diagnosis is doubtful.
Collapse
Affiliation(s)
- Mohamad A Mouchli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Carilion Clinic, Roanoke, Virginia, USA
| | - Sarah E Kerr
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lewis Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Karydis I, Gangi A, Wheater MJ, Choi J, Wilson I, Thomas K, Pearce N, Takhar A, Gupta S, Hardman D, Sileno S, Stedman B, Zager JS, Ottensmeier C. Percutaneous hepatic perfusion with melphalan in uveal melanoma: A safe and effective treatment modality in an orphan disease. J Surg Oncol 2018; 117:1170-1178. [PMID: 29284076 PMCID: PMC6033148 DOI: 10.1002/jso.24956] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/18/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metastatic uveal melanoma (UM) carries a poor prognosis; liver is the most frequent and often solitary site of recurrence. Available systemic treatments have not improved outcomes. Melphalan percutaneous hepatic perfusion (M-PHP) allows selective intrahepatic delivery of high dose cytotoxic chemotherapy. METHODS Retrospective analysis of outcomes data of UM patients receiving M-PHP at two institutions was performed. Tumor response and toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) v4.03, respectively. RESULTS A total of 51 patients received 134 M-PHP procedures (median of 2 M-PHPs). 25 (49%) achieved a partial (N = 22, 43.1%) or complete hepatic response (N = 3, 5.9%). In 17 (33.3%) additional patients, the disease stabilized for at least 3 months, for a hepatic disease control rate of 82.4%. After median follow-up of 367 days, median overall progression free (PFS) and hepatic progression free survival (hPFS) was 8.1 and 9.1 months, respectively and median overall survival was 15.3 months. There were no treatment related fatalities. Non-hematologic grade 3-4 events were seen in 19 (37.5%) patients and were mainly coagulopathic (N = 8) and cardiovascular (N = 9). CONCLUSIONS M-PHP results in durable intrahepatic disease control and can form the basis for an integrated multimodality treatment approach in appropriately selected UM patients.
Collapse
Affiliation(s)
- Ioannis Karydis
- Cancer Sciences Academic UnitUniversity of SouthamptonSouthamptonUnited Kingdom
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Alexandra Gangi
- Department of Cutaneous OncologyMoffitt Cancer CenterTampaFlorida
| | | | - Junsung Choi
- Department of RadiologyMoffitt Cancer CenterTampaFlorida
| | - Iain Wilson
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Kerry Thomas
- Department of RadiologyMoffitt Cancer CenterTampaFlorida
| | - Neil Pearce
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Arjun Takhar
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Sanjay Gupta
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Danielle Hardman
- Morsani School of MedicineUniversity of South FloridaTampaFlorida
| | - Sean Sileno
- Morsani School of MedicineUniversity of South FloridaTampaFlorida
| | - Brian Stedman
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | | | - Christian Ottensmeier
- Cancer Sciences Academic UnitUniversity of SouthamptonSouthamptonUnited Kingdom
- University Hospital SouthamptonSouthamptonUnited Kingdom
| |
Collapse
|
4
|
Glazer ES, Zager JS. Chemosaturation with Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases. Cancer Control 2017; 24:96-101. [DOI: 10.1177/107327481702400116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In patients with hepatic metastases from solid-organ malignancies, surgical resection may be a potentially curative option, but it is not possible in most cases. Chemosaturation with percutaneous hepatic perfusion was developed for the management of unresectable metastases to the liver. Methods Relevant medical literature was summarized with regard to the outcomes and limitations of chemosaturation with percutaneous hepatic perfusion. Results Six articles were identified that contained data on 91 individuals who received chemosaturation with percutaneous hepatic perfusion. More than 60% of these study patients were diagnosed with ocular melanoma. The overall response rate was 48% and the rate of disease control was 90%. Chemosaturation with percutaneous hepatic perfusion improved the rates of overall and hepatic progression-free survival (PFS). The data are limited but suggest that the rate of PFS was improved in study patients with isolated melanoma hepatic metastases who received chemosaturation with percutaneous hepatic perfusion compared with those assigned to standard care. Conclusions Our results suggest that chemosaturation with percutaneous hepatic perfusion produces favorable tumor response rates in select individuals with unresectable hepatic metastases from multiple primary cancers, particularly ocular and cutaneous melanomas. Data from a single randomized clinical trial have also shown that chemosaturation with percutaneous hepatic perfusion can affect hepatic PFS in certain patients.
Collapse
Affiliation(s)
- Evan S. Glazer
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Surgical Oncology in the Department of Surgery at the University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
5
|
Abstract
Isolated hepatic perfusion uses the unique vascular supply of hepatic malignancies to deliver cytotoxic chemotherapy. The procedure involves vascular isolation of the liver and delivery of chemotherapy via the hepatic artery and extraction from retrohepatic vena cava. Benefits of hepatic perfusion have been observed in hepatic metastases of ocular melanoma and colorectal cancer and primary hepatocellular carcinoma. Percutaneous and prophylactic perfusions are avenues of ongoing research.
Collapse
Affiliation(s)
- Rahul Rajeev
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| |
Collapse
|
6
|
Hughes MS, Zager J, Faries M, Alexander HR, Royal RE, Wood B, Choi J, McCluskey K, Whitman E, Agarwala S, Siskin G, Nutting C, Toomey MA, Webb C, Beresnev T, Pingpank JF. Results of a Randomized Controlled Multicenter Phase III Trial of Percutaneous Hepatic Perfusion Compared with Best Available Care for Patients with Melanoma Liver Metastases. Ann Surg Oncol 2015; 23:1309-19. [PMID: 26597368 DOI: 10.1245/s10434-015-4968-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE There is no consensus for the treatment of melanoma metastatic to the liver. Percutaneous hepatic perfusion with melphalan (PHP-Mel) is a method of delivering regional chemotherapy selectively to the liver. In this study, we report the results of a multicenter, randomized controlled trial comparing PHP-Mel with best alternative care (BAC) for patients with ocular or cutaneous melanoma metastatic to the liver. PATIENTS AND METHODS A total of 93 patients were randomized to PHP-Mel (n = 44) or BAC (n = 49). On the PHP-Mel arm, melphalan was delivered via the hepatic artery, and the hepatic effluent captured and filtered extracorporeally prior to return to the systemic circulation via a venovenous bypass circuit. PHP-Mel was repeatable every 4-8 weeks. The primary endpoint was hepatic progression-free survival (hPFS), and secondary endpoints included overall PFS (oPFS), overall survival (OS), hepatic objective response (hOR), and safety. RESULTS hPFS was 7.0 months for PHP-Mel and 1.6 months for BAC (p < 0.0001), while oPFS was 5.4 months for PHP-Mel and 1.6 months for BAC (p < 0.0001). Median OS was not significantly different (PHP-Mel 10.6 months vs. BAC 10.0 months), likely due to crossover to PHP-Mel treatment (57.1 %) from the BAC arm, and the hOR was 36.4 % for PHP-Mel and 2.0 % for BAC (p < 0.001). The majority of adverse events were related to bone marrow suppression. Four deaths were attributed to PHP-Mel, three in the primary PHP-Mel group, and one post-crossover to PHP-Mel from BAC. CONCLUSION This randomized, phase III study demonstrated the efficacy of the PHP-Mel procedure. hPFS, oPFS, and hOR were significantly improved with PHP-Mel. PHP with melphalan should provide a new treatment option for unresectable metastatic melanoma in the liver.
Collapse
Affiliation(s)
- Marybeth S Hughes
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jonathan Zager
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mark Faries
- John Wayne Cancer Institute, Providence St. John's Health Center, Santa Monica, CA, USA
| | - H Richard Alexander
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Richard E Royal
- M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Bradford Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | - Junsung Choi
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kevin McCluskey
- University of Pittsburgh Schools of the Health Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric Whitman
- Carol G. Simon Cancer Center, Atlantic Health System, Morristown, NJ, USA
| | | | - Gary Siskin
- Albany Medical Neurosciences Institute, Albany, NY, USA
| | | | - Mary Ann Toomey
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Carole Webb
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tatiana Beresnev
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - James F Pingpank
- University of Pittsburgh Schools of the Health Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Division of Hepatobiliary Surgery, Surgical Oncology Services, Hillman Cancer Center, UPMC, Pittsburgh, PA, USA.
| |
Collapse
|
7
|
Transarterial Chemoembolization of Liver Metastases from Uveal Melanoma Using Irinotecan-Loaded Beads: Treatment Response and Complications. Cardiovasc Intervent Radiol 2015; 38:1532-41. [PMID: 25832764 DOI: 10.1007/s00270-015-1093-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/15/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate treatment response and complications of transarterial chemoembolization using drug-eluting beads loaded with irinotecan (DEBIRI) in patients with liver metastases from uveal melanoma (UM). MATERIALS AND METHODS Patients treated with DEBIRI (n = 14) were retrospectively analyzed regarding overall survival, compared to patients (n = 14) treated with intravenous dacarbazine (DTIC). Median overall survival was calculated from time of diagnosis of metastatic disease (OS1) and start of treatment (OS2). Radiological response for DEBIRI was assessed according to RECIST 1.1 on contrast-enhanced computed tomography (CT), obtained 1.5 months (range 1.2-3.7) post treatment. Major complications of DEBIRI were defined according to the Society of Interventional Radiology classification for complications by outcome. RESULTS In the DEBIRI group, OS1 was 14.8 months (range 3.9-47.5), and OS2 was 9.4 months (range 1.7-39). Further, 11/13 (84.6%) of these patients had progressive disease on first follow-up CT and new lesions were seen in nine. There were 12 major complications in nine patients, possibly including one case of mortality due to disseminated intravascular coagulation (DIC). CONCLUSION For patients with liver metastases from UM, the effect on overall survival of DEBIRI alone is questionable. Compared to previous reports, the response rate of DEBIRI was poor, with new liver lesions observed in the majority of patients. Major complications possibly included one case of DIC.
Collapse
|
8
|
Rashid OM, Sloot S, Zager JS. Regional therapy in metastatic melanoma: an update on minimally invasive intraarterial isolated limb infusion and percutaneous hepatic perfusion. Expert Opin Drug Metab Toxicol 2014; 10:1355-64. [DOI: 10.1517/17425255.2014.951330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|