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Carr MJ, Sun J, Cohen JB, Liu J, Serdiuk AA, Stewart SR, Doobay N, Duclos A, Seal DA, Choi J, Zager JS. Over 12 Years Single Institutional Experience Performing Percutaneous Hepatic Perfusion for Unresectable Liver Metastases. Cancer Control 2021; 27:1073274820983019. [PMID: 33372814 PMCID: PMC8480350 DOI: 10.1177/1073274820983019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with unresectable hepatic metastases, from uveal or ocular melanoma, are challenging to treat with an overall poor prognosis. Although over the past decade significant advances in systemic therapies have been made, metastatic disease to the liver, especially from uveal melanoma, continues to be a poor prognosis. Percutaneous hepatic perfusion (PHP) is a safe, viable treatment option for these patients. PHP utilizes high dose chemotherapy delivered directly to the liver while minimizing systemic exposure and can be repeated up to 6 times. Isolation of the hepatic vasculature with a double-balloon catheter allows for high concentration cytotoxic therapy to be administered with minimal systemic adverse effects. A detailed description of the multidisciplinary treatment protocol used at an institution with over 12 years of experience is discussed and recommendations are given. A dedicated team of a surgical or medical oncology, interventional radiology, anesthesiology and a perfusionist allows PHP to be repeatedly performed as a safe treatment strategy for unresectable hepatic metastases.
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Affiliation(s)
- Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan B Cohen
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jinhong Liu
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Andrew A Serdiuk
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Stephen R Stewart
- Certified Clinical Perfusionist, Moffitt Cancer Center, Tampa, FL, USA
| | - Navin Doobay
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew Duclos
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - David A Seal
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Junsung Choi
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA. Sun is now with the Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Yee C, McCoy D, Yu J, Losey A, Jordan C, Moore T, Stillson C, Oh HJ, Kilbride B, Roy S, Patel A, Wilson MW, Hetts SW. Endovascular Ion Exchange Chemofiltration Device Reduces Off-Target Doxorubicin Exposure in a Hepatic Intra-arterial Chemotherapy Model. Radiol Imaging Cancer 2019; 1:e190009. [PMID: 32300759 DOI: 10.1148/rycan.2019190009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
Purpose To determine if endovascular chemofiltration with an ionic device (ChemoFilter [CF]) can be used to reduce systemic exposure and off-target biodistribution of doxorubicin (DOX) during hepatic intra-arterial chemotherapy (IAC) in a preclinical model. Materials and Methods Hepatic IAC infusions were performed in six pigs with normal livers. Animals underwent two 10-minute intra-arterial infusions of DOX (200 mg) into the common hepatic artery. Both the treatment group and the control group received initial IAC at 0 minutes and a second dose at 200 minutes. Prior to the second dose, CF devices were deployed in and adjacent to the hepatic venous outflow tract of treatment animals. Systemic exposure to DOX was monitored via blood samples taken during IAC procedures. After euthanasia, organ tissue DOX concentrations were analyzed. Alterations in systemic DOX exposure and biodistribution were compared by using one-tailed t tests. Results CF devices were well tolerated, and no hemodynamic, thrombotic, or immunologic complications were observed. Animals treated with a CF device had a significant reduction in systemic exposure when compared with systemic exposure in the control group (P <.009). Treatment with a CF device caused a significant decrease in peak DOX concentration (31%, P <.01) and increased the time to maximum concentration (P <.03). Tissue analysis was used to confirm significant reduction in DOX accumulation in the heart and kidneys (P <.001 and P <.022, respectively). Mean tissue concentrations in the heart, kidneys, and liver of animals treated with CF compared with those in control animals were 14.2 μg/g ± 1.9 (standard deviation) versus 26.0 μg/g ± 1.8, 46.4 μg/g ± 4.6 versus 172.6 μg/g ± 40.2, and 217.0 μg/g ± 5.1 versus 236.8 μg/g ± 9.0, respectively. Fluorescence imaging was used to confirm in vivo DOX binding to CF devices. Conclusion Reduced systemic exposure and heart bioaccumulation of DOX during local-regional chemotherapy to the liver can be achieved through in situ adsorption by minimally invasive image-guided CF devices.© RSNA, 2019.
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Affiliation(s)
- Colin Yee
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - David McCoy
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Jay Yu
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Aaron Losey
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Caroline Jordan
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Terilyn Moore
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Carol Stillson
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Hee Jeung Oh
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Bridget Kilbride
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Shuvo Roy
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Anand Patel
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
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