• Deepa Magge, Haroon A Choudry, Herbert J Zeh, Diana E Cunningham, Jennifer Steel, Matthew P Holtzman, Heather L Jones, James F Pingpank, David L Bartlett, and Amer H Zureikat.
• *Division of Surgical Oncology, Koch Regional Perfusion Center and †Department of Psychiatry, University of Pittsburgh Medical Center ‡Biostatistics Facility, University of Pittsburgh Cancer Institute, PA.
• Ann. Surg. 2014 May 1; 259 (5): 953-9.

ObjectiveTo evaluate outcomes of isolated hepatic perfusion (IHP) on isolated liver metastases (LMs).BackgroundIsolated unresectable LMs are often the main determinant of overall survival (OS) for colorectal cancer (CRC) and other solid malignancies. We hypothesized that IHP can be performed safely and yield impressive responses for a variety of solid tumor pathology, using different perfusion agents.MethodsRetrospective review of a prospectively collected database of patients undergoing IHP for unresectable solid tumor LM.ResultsBetween 2003 and 2012, IHP was completed in 91 patients. Primary tumor pathology was CRC = 54, non-CRC = 37 (ocular/cutaneous melanoma = 32, cholangiocarcinoma = 3, appendiceal = 1, and breast = 1). IHP employed Melphalan (n = 69) (CRC = 32, non-CRC = 37), Oxaliplatin (n = 10) (CRC), or Oxaliplatin + 5FU (n = 12) (CRC). Hepatic arterial infusion (HAI) pumps were placed in all CRC patients. There were 3(3.3%) perioperative deaths. Response rates for CRC, melanoma, and cholangiocarcinoma were 68.2%, 57.1%, and 100% respectively. Response rates for CRC patients using 5FU + Oxaliplatin, Oxaliplatin, or Melphalan were 83.3%, 66.7%, and 60.9%, respectively. Median OS for the CRC patients (from IHP date) was 23 months (95% confidence interval: 15-28 months). On univariate analysis, receipt of HAI-FUDR (floxuridine) within 1 year of IHP was the only factor associated with improved OS (P = 0.043) in CRC patients.ConclusionsIHP results in excellent response rates for patients with unresectable liver metastasis from solid tumors. Improved local control for CRC patients undergoing IHP-HAI may improve survival.

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