Patients with melanoma that had spread to the liver who underwent percutaneous hepatic perfusion survived four times longer before the disease progressed, compared to patients who did not receive the treatment, according to results of the multicentre randomised study.
The study included 93 patients: 44 received percutaneous hepatic perfusion and 49 received standard treatment (typically systemic chemotherapy). In the latter group, 27 began receiving percutaneous hepatic perfusion when their disease progressed. Patients in the percutaneous hepatic perfusion group averaged 186 days before the disease progressed compared to 46 days for patients who did not receive percutaneous hepatic perfusion. Those in the percutaneous hepatic perfusion group benefitted from an average of 245 days without progression of cancer in the liver compared to 49 days for those in the standard treatment group, a five-fold increase for the percutaneous hepatic perfusion group.
“The minimally invasive method isolates the drug so it is contained within the liver, where tumours receive up to 100 times the dose they would get through systemic chemotherapy,” said investigator Charles Nutting, an interventional radiologist at Skyridge Medical Center, Denver, USA. “There are very limited therapeutic options for these patients. This minimally invasive therapy technology could eventually be used to treat other liver cancers when options are limited.”
Percutaneous hepatic perfusion involves delivering chemotherapy via an arterial catheter threaded through the blood vessels to the liver. Two balloons are inflated in the vena cava, above and below the liver to isolate the chemotherapy. This chemotherapy-saturated blood is then cleansed by a series of filters and returned to the body. Percutaneous hepatic perfusion allows the entire liver to be treated, which is beneficial in patients with more than one tumour. In standard chemotherapy, the drug circulates throughout the entire circulation system and doses must be minimised to prevent damage to healthy tissues. Localised chemotherapy involves delivering treatment to specific tumours, enabling high doses to be delivered, but the method is more challenging when there are multiple tumours.
