Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center

H. Richard Alexander, David L. Bartlett, Steven K. Libutti, James F. Pingpank, Douglas L. Fraker, Richard Royal, Seth M. Steinberg, Cynthia B. Helsabeck, Tatiana H. Beresneva

Research output: Contribution to journalArticle

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Abstract

Aim: To define the indications for hyperthermic isolated hepatic perfusion (IHP) in patients with unresectable liver metastases (LM) from colorectal cancer (CRC) with particular focus on IHP's utility as a second-line option for patients whose tumors have progressed following combination systemic chemotherapy treatment. Methods: From June 1994 through July 2005, 120 patients with unresectable CRC LM underwent IHP with melphalan (n = 69), tumor necrosis factor (TNF) (n = 10) or both (n = 41). Hepatic arterial infusion (HAI) with floxuridine started 6-8 weeks post IHP in 46 (38%). Patients were followed for toxicity, radiographic response, and overall survival (OS). Wilcoxon rank-sum and Fisher's exact tests were used to compare parameters by response category; survival and hepatic progression-free survival were calculated by the Kaplan-Meier method. Results: Of 79 males and 41 females, 96 (80%) received prior chemotherapy. There were five (4%) operative/treatment mortalities. There were 69 responses in 114 evaluable patients (61%). Total melphalan dose and combination melphalan/TNF were each associated with response; age, preoperative carcinoembryonic antigen (CEA), prior chemotherapy for established LM, tumor burden, and post-IHP HAI therapy were not. Median overall survival was 17.4 months and 2-year survival was 34%. Factors found to be independently related to survival were preoperative CEA <30 ng/mL and use of post-IHP HAI (P < 0.015). Conclusions: IHP results in marked tumor regression and prolonged survival in patients with CRC LM. Continued development of IHP in this clinical setting is warranted.

Original languageEnglish (US)
Pages (from-to)1852-1859
Number of pages8
JournalAnnals of Surgical Oncology
Volume16
Issue number7
DOIs
StatePublished - Jul 2009
Externally publishedYes

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Statistical Factor Analysis
Perfusion
Neoplasm Metastasis
Liver
Melphalan
Survival
Colorectal Neoplasms
Carcinoembryonic Antigen
Liver Neoplasms
Tumor Necrosis Factor-alpha
Floxuridine
Drug Therapy
Combination Drug Therapy
Tumor Burden
Disease-Free Survival
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center. / Alexander, H. Richard; Bartlett, David L.; Libutti, Steven K.; Pingpank, James F.; Fraker, Douglas L.; Royal, Richard; Steinberg, Seth M.; Helsabeck, Cynthia B.; Beresneva, Tatiana H.

In: Annals of Surgical Oncology, Vol. 16, No. 7, 07.2009, p. 1852-1859.

Research output: Contribution to journalArticle

Alexander, HR, Bartlett, DL, Libutti, SK, Pingpank, JF, Fraker, DL, Royal, R, Steinberg, SM, Helsabeck, CB & Beresneva, TH 2009, 'Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center', Annals of Surgical Oncology, vol. 16, no. 7, pp. 1852-1859. https://doi.org/10.1245/s10434-009-0482-9
Alexander, H. Richard ; Bartlett, David L. ; Libutti, Steven K. ; Pingpank, James F. ; Fraker, Douglas L. ; Royal, Richard ; Steinberg, Seth M. ; Helsabeck, Cynthia B. ; Beresneva, Tatiana H. / Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 7. pp. 1852-1859.
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abstract = "Aim: To define the indications for hyperthermic isolated hepatic perfusion (IHP) in patients with unresectable liver metastases (LM) from colorectal cancer (CRC) with particular focus on IHP's utility as a second-line option for patients whose tumors have progressed following combination systemic chemotherapy treatment. Methods: From June 1994 through July 2005, 120 patients with unresectable CRC LM underwent IHP with melphalan (n = 69), tumor necrosis factor (TNF) (n = 10) or both (n = 41). Hepatic arterial infusion (HAI) with floxuridine started 6-8 weeks post IHP in 46 (38{\%}). Patients were followed for toxicity, radiographic response, and overall survival (OS). Wilcoxon rank-sum and Fisher's exact tests were used to compare parameters by response category; survival and hepatic progression-free survival were calculated by the Kaplan-Meier method. Results: Of 79 males and 41 females, 96 (80{\%}) received prior chemotherapy. There were five (4{\%}) operative/treatment mortalities. There were 69 responses in 114 evaluable patients (61{\%}). Total melphalan dose and combination melphalan/TNF were each associated with response; age, preoperative carcinoembryonic antigen (CEA), prior chemotherapy for established LM, tumor burden, and post-IHP HAI therapy were not. Median overall survival was 17.4 months and 2-year survival was 34{\%}. Factors found to be independently related to survival were preoperative CEA <30 ng/mL and use of post-IHP HAI (P < 0.015). Conclusions: IHP results in marked tumor regression and prolonged survival in patients with CRC LM. Continued development of IHP in this clinical setting is warranted.",
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T1 - Analysis of factors associated with outcome in patients undergoing isolated hepatic perfusion for unresectable liver metastases from colorectal center

AU - Alexander, H. Richard

AU - Bartlett, David L.

AU - Libutti, Steven K.

AU - Pingpank, James F.

AU - Fraker, Douglas L.

AU - Royal, Richard

AU - Steinberg, Seth M.

AU - Helsabeck, Cynthia B.

AU - Beresneva, Tatiana H.

PY - 2009/7

Y1 - 2009/7

N2 - Aim: To define the indications for hyperthermic isolated hepatic perfusion (IHP) in patients with unresectable liver metastases (LM) from colorectal cancer (CRC) with particular focus on IHP's utility as a second-line option for patients whose tumors have progressed following combination systemic chemotherapy treatment. Methods: From June 1994 through July 2005, 120 patients with unresectable CRC LM underwent IHP with melphalan (n = 69), tumor necrosis factor (TNF) (n = 10) or both (n = 41). Hepatic arterial infusion (HAI) with floxuridine started 6-8 weeks post IHP in 46 (38%). Patients were followed for toxicity, radiographic response, and overall survival (OS). Wilcoxon rank-sum and Fisher's exact tests were used to compare parameters by response category; survival and hepatic progression-free survival were calculated by the Kaplan-Meier method. Results: Of 79 males and 41 females, 96 (80%) received prior chemotherapy. There were five (4%) operative/treatment mortalities. There were 69 responses in 114 evaluable patients (61%). Total melphalan dose and combination melphalan/TNF were each associated with response; age, preoperative carcinoembryonic antigen (CEA), prior chemotherapy for established LM, tumor burden, and post-IHP HAI therapy were not. Median overall survival was 17.4 months and 2-year survival was 34%. Factors found to be independently related to survival were preoperative CEA <30 ng/mL and use of post-IHP HAI (P < 0.015). Conclusions: IHP results in marked tumor regression and prolonged survival in patients with CRC LM. Continued development of IHP in this clinical setting is warranted.

AB - Aim: To define the indications for hyperthermic isolated hepatic perfusion (IHP) in patients with unresectable liver metastases (LM) from colorectal cancer (CRC) with particular focus on IHP's utility as a second-line option for patients whose tumors have progressed following combination systemic chemotherapy treatment. Methods: From June 1994 through July 2005, 120 patients with unresectable CRC LM underwent IHP with melphalan (n = 69), tumor necrosis factor (TNF) (n = 10) or both (n = 41). Hepatic arterial infusion (HAI) with floxuridine started 6-8 weeks post IHP in 46 (38%). Patients were followed for toxicity, radiographic response, and overall survival (OS). Wilcoxon rank-sum and Fisher's exact tests were used to compare parameters by response category; survival and hepatic progression-free survival were calculated by the Kaplan-Meier method. Results: Of 79 males and 41 females, 96 (80%) received prior chemotherapy. There were five (4%) operative/treatment mortalities. There were 69 responses in 114 evaluable patients (61%). Total melphalan dose and combination melphalan/TNF were each associated with response; age, preoperative carcinoembryonic antigen (CEA), prior chemotherapy for established LM, tumor burden, and post-IHP HAI therapy were not. Median overall survival was 17.4 months and 2-year survival was 34%. Factors found to be independently related to survival were preoperative CEA <30 ng/mL and use of post-IHP HAI (P < 0.015). Conclusions: IHP results in marked tumor regression and prolonged survival in patients with CRC LM. Continued development of IHP in this clinical setting is warranted.

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