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Annals of Oncology Advance Access originally published online on February 27, 2008
Annals of Oncology 2008 19(6):1127-1134; doi:10.1093/annonc/mdn032
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gastrointestinal tumors

Isolated hepatic melphalan perfusion of colorectal liver metastases: outcome and prognostic factors in 154 patients

L. B. J. van Iersel1, H. Gelderblom1, A. L. Vahrmeijer2, E. L. van Persijn van Meerten3, F. G. J. Tijl4, H. Putter5, H. H. Hartgrink2, P. J. K. Kuppen2, J. W. R. Nortier1, R. A. E. M. Tollenaar2 and C. J. H. van de Velde2

1 Department of Clinical Oncology
2 Department of Surgery
3 Department of Radiology
4 Department of Extra Corporal Circulation
5 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to: Dr L. B. J. van Iersel, Department of Clinical Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31-71-5263057; Fax; +31-71-5266760; E-mail: l.b.j.van_iersel{at}lumc.nl

Background: The aim of this study was to identify prognostic factors for local and systemic failure after isolated hepatic perfusion (IHP) with 200 mg melphalan in patients with colorectal liver metastases.

Patients and methods: Hundred and fifty-four patients were selected for IHP and underwent laparotomy. Patients were monitored for response, toxicity and survival. Univariate and multivariate analyses were carried out to identify prognostic factors for hepatic response and progression-free and overall survival.

Results: Hepatic response rate was 50% with a median progression-free and overall survival of, respectively, 7.4 and 24.8 months. In multivariate analyses, absence of ability to perfuse through the hepatic artery (P = 0.003), severe postoperative complications (P = 0.048) and >10 liver metastases (P = 0.006) adversely influenced overall survival and no adjuvant chemotherapy adversely influenced progression-free survival.

Conclusion: This is the first study to report prognostic factors for survival after IHP. Possibly, overall and disease-free survival can increase if preoperative screening is improved. In future studies on IHP, adjuvant chemotherapy should be considered.

Key words: colorectal cancer, isolated hepatic perfusion, liver metastases, melphalan, prognostic factors

Received for publication October 5, 2007. Revision received January 1, 2008. Accepted for publication January 17, 2008.


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