Vogl T J, Zangos S, Scholtz J E, Schmitt F, Paetzold S, Trojan J, Orsi F, Lotz G, Ferrucci P
Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt.
Department of Dermatology, Venerology and Allergology, University Hospital of Frankfurt.
Rofo. 2014 Oct;186(10):937-44. doi: 10.1055/s-0034-1366081. Epub 2014 Apr 11.
Chemosaturation with percutaneous hepatic perfusion (PHP; Hepatic CHEMOSAT(®) Delivery System; Delcath Systems Inc, USA) is a minimally invasive, repeatable regional therapy for unresectable hepatic metastases. It uses a system of catheters and filters to isolate hepatic venous blood from the systemic circulation, allowing delivery of high-dose chemotherapy to the hepatic artery. Effluent hepatic venous blood is filtered before being returned to the systemic circulation, thereby reducing exposure to chemotherapy. We describe our experiences with chemosaturation-PHP at 2 European centers.
14 patients presented unresectable hepatic metastases from solid tumors; 13 received 1 - 3 sessions of chemosaturation-PHP. Melphalan 2.0 (n = 1) or 3.0 (n = 12) mg/kg was given as a 30-minute infusion into the hepatic artery. 12 patients were evaluable for tumor response.
One complete (cholangiocarcinoma, n = 1) and 6 partial responses (ocular, n = 3 or cutaneous melanoma, n = 3) were observed, 5 patients had stable disease (ocular melanoma, n = 3; breast cancer, n = 1; gastric cancer, n = 1). Mild to moderate filter-related toxicity (i. e. thrombocytopenia, anemia) was observed immediately post-procedure. Grade 3/4 melphalan-related pancytopenia developed after 1 - 2 weeks. All hematological events were managed effectively with transfusions and/or other supportive measures. The new high-efficiency filter showed milder toxicity and faster recovery. In one case, chemosaturation-PHP was abandoned prematurely due to heparin-induced vaginal bleeding, and one patient died due to retroperitoneal hemorrhage from heparin anti-coagulation.
Chemosaturation-PHP for non-resectable liver metastases is a feasible treatment option when performed by an experienced multi-disciplinary team. It may be a promising regional therapy for patients with no effective treatment options.
经皮肝灌注化疗（PHP；Hepatic CHEMOSAT®输送系统；美国Delcath Systems公司）化学饱和法是一种针对不可切除肝转移瘤的微创、可重复的区域治疗方法。它使用导管和过滤器系统将肝静脉血与体循环隔离，使高剂量化疗药物能够输送至肝动脉。肝静脉流出的血液在返回体循环之前经过过滤，从而减少化疗药物暴露。我们描述了在2个欧洲中心进行化学饱和法-PHP的经验。
14例患者存在实体瘤不可切除的肝转移；13例接受了1-3个疗程的化学饱和法-PHP治疗。美法仑2.0（n=1）或3.0（n=12）mg/kg经30分钟输注至肝动脉。12例患者可评估肿瘤反应。
观察到1例完全缓解（胆管癌，n=1）和6例部分缓解（眼癌，n=3或皮肤黑色素瘤，n=3），5例患者疾病稳定（眼黑色素瘤，n=3；乳腺癌，n=1；胃癌，n=1）。术后立即观察到轻度至中度与过滤器相关的毒性（即血小板减少、贫血）。1-2周后出现3/4级与美法仑相关的全血细胞减少。所有血液学事件均通过输血和/或其他支持措施得到有效处理。新型高效过滤器显示出毒性较轻且恢复较快。1例患者因肝素诱导的阴道出血而提前放弃化学饱和法-PHP治疗，1例患者因肝素抗凝导致腹膜后出血死亡。
由经验丰富的多学科团队进行化学饱和法-PHP治疗不可切除肝转移瘤是一种可行的治疗选择。对于没有有效治疗方案的患者，它可能是一种有前景的区域治疗方法。
