Heaptic Arterial Infusion Chemotherapy for Colorectal Liver Metastases - A Single Center`s Experience and a Pictorial Imaging Review
2Davidoff Cancer Center, Rabin Medical Center Beilinson Hospital, Israel
3Sackler Faculty of Medicine, Tel Aviv University, Israel
Purpose: Hepatic arterial infusion (HAI) requires surgical placement of a subcutaneous port which delivers selective chemotherapy directly to the hepatic artery, thus maximizing hepatic drug concentrations while minimizing systemic toxicity.
HAI may be considered in select clinical scenarios of primary or secondary liver cancer, including adjuvant therapy in resectable disease, conversion therapy for unresectable liver-dominant disease, and palliative therapy for unresectable disease.
We present our experience in implementing the first HAI chemotherapy program in Israel. This is a single center experience from the radiologist`s point of view highlighting our role in the selection and management of these patients.
Methods and Materials: Prospectively collected data from patients with unresectable colorectal liver metastases (CRLM) between February 2020 and May 2021.
CT scans were performed 0-3 months prior to surgery and every 3 months post-surgery. Objective radiological response (ORR) was defined according to RECIST version 1.1, measured by an abdominal radiologist.
Results: 21 patients (12M:9F, mean age 56) with unresectable CRLM underwent HAI port implantation, median number of CRLM 9, median size of largest metastasis 5.5cm. All patients received prior chemotherapy with an average of 17 pre-HAIP cycles.
Partial response, stable disease, and progressive disease were noted in 9, 4 and 1 patients after 6 months, respectively. RECIST was not applicable in 7 patients with no target lesions, most due to resection or ablation at the time of port implantation.
Related complications were noted in 3 (14%) patients, diagnosed radiologically, and managed with collaboration of the interventional radiology unit. No mortality has occurred as of yet.
Conclusion: Implementation of HAI program in Israel was feasible, and although early in the program experience, the low and acceptable complication rates in this cohort of patients (heavily pretreated with chemotherapy) are encouraging. The radiologists play a pivotal role in the selection and management of these patients.