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Recent Developments in Isolated Hepatic Perfusion as an Alternative in the Treatment of Unresectable Metastatic Liver Disease Secondary to Colorectal Cancer

January-March 2016, Volume 03, Number 1
Osvaldo A Quiroz-Sandoval, Horacio N. López-Basave, Pabel Miranda-Aguirre, Alejandro E. Padilla-Rosciano, Alberto Tenorio-Torres, Gerardo Guzmán-Flores and Edgardo Jiménez-Fuentes
Department of Gastrointestinal Tumors, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico

Colorectal cancer (CRC) is the third most common cause of death from cancer worldwide. Nearly 20% of patients present with synchronous metastatic disease at the time of diagnosis and up to 50% of patients will develop liver metastases at some point during the course of their disease. It is said that approximately 85% of patients with stage IV disease present with liver metastases that are considered unresectable at the time of diagnosis. The median survival for these patients without treatment is 6-9 months and it reaches up to 35% at five years when they are converted to resection. Many techniques for the regional treatment of liver metastases from CRC have been described, based either on ablative therapy (radiofrequency ablation, cryoablation, microwave ablation) or perfusion (chemoembolization, radioembolization, infusion of chemotherapy directly into the hepatic artery); each of these techniques has been shown to be effective within their domain. Still, no comparative studies have been conducted to establish precise indications for opting for one of these techniques over another and the benefits of each. At present the only treatment for unresectable liver metastases from CRC that has been validated continues to be systemic treatment with chemotherapy. The rationale for isolated hepatic perfusion is based on administering high doses of chemotherapeutic agents by infusing them through the liver under hyperthermic conditions in order to produce maximum antitumor effects while limiting systemic toxicity by temporary interruption of the blood supply to the liver. Numerous studies have reported responses of more than 50-60%, with complete radiologic response in up to 5% of the cases reported and with acceptable transient perioperative morbidity and mortality rates with respect to the other modalities of systemic treatment currently in use. The importance of evaluating this new therapeutic tool is that, with the exception of surgical resection with negative margins, overall survival rates for all of the other treatments currently available for patients with unresectable liver metastases from CRC are too low.

Key words:
Isolated hepatic perfusion, hyperthermia, colorectal cancer, unresectable liver metastases.
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