HPB2 - Implementation of a Hepatic Artery Infusion Program: Initial Patient Selection and Perioperative Outcomes of Concurrent HAI and Systemic Chemotherapy for Colorectal Liver Metastases
Saturday, February 15, 2020
7:45 AM – 8:00 AM
Location: Sebastian I 1/2
Introduction: Hepatic artery infusion (HAI) combined with systemic chemotherapy is a treatment strategy for patients with unresectable liver-only or liver-dominant colorectal liver metastases (CRLM). While HAI has previously been performed in only a few centers, the purpose of this study was to describe patient selection and perioperative outcomes during implementation of a new HAI program.
Methods: Patients with unresectable CRLM were selected for HAI after multi-disciplinary review. Demographics, disease burden, prior treatment, and perioperative outcomes were assessed. Objective hepatic response was calculated according to RECIST 1.1.
Results: Fifteen patients with CRLM were treated with HAI between November 2018-September 2019. Median age was 51 years (range 33-80). Most patients had synchronous disease (n=13, 87%) and received prior chemotherapy (n=14, 93%) with extended treatment cycles (median 16, IQR 8-21). Median number of CRLM was 8 (IQR 5-17) and all patients had bilobar disease. Operations were often performed with combined hepatectomy (n=2, 13%) or colectomy/proctectomy (n=8, 53%). Median operating time was 295 minutes (range 130-488) with EBL of 100 ml (range 22-350). HAI-specific complications included: pump pocket seroma, hematoma, and extrahepatic perfusion (each n=1, 7%). HAI was initiated in 14 patients (93%). Three-month hepatic response (n=7) included 2 Partial Response (29%), 4 Stable Disease (57%), and 1 Progression of Disease (14%), yielding a disease control rate (DCR) of 86%.
Conclusion: Implementation of a new HAI program is feasible, and HAI can be safely delivered to selected patients with CRLM. Initial response and DCR are promising, even in patients heavily pre-treated with chemotherapy.