Development of Isolated Hepatic Perfusion via the Operative and Percutaneous Techniques for Patients With Isolated and Unresectable Liver Metastases

The development of effective treatment strategies to provide durable control of isolated diffuse metastases to the liver is a major challenge in clinical oncology. The number of patients afflicted annually with isolated liver metastases is considerable; of the 156,000 patients diagnosed with colorectal cancer in 2009, it is estimated that up to 40,000 will develop liver metastases as the sole or dominant site of disease progression and of whom only 10% to 20% will have tumors amenable to resection. Patients with neuroendocrine cancers and ocular melanoma will frequently develop isolated and diffuse liver metastases as the dominant mode of tumor metastasis and, although less frequent, patients with other types of cancers such as cutaneous melanoma or breast cancer can occasionally develop isolated diffuse metastases to the liver. Isolated hepatic perfusion and percutaneous hepatic perfusion are under clinical evaluation for patients with diffuse isolated liver metastases from various solid organ cancers. Both share the advantages of intensifying treatment to the cancer-burdened organ of the body to improve efficacy and limit unnecessary systemic toxicity by selectively delivering high-dose therapeutic agents into the hepatic arterial system from which established metastases derive their predominant blood supply. In this article, we will review the history and early clinical development of isolated perfusion, the techniques of isolated hepatic perfusion and percutaneous hepatic perfusion, the current clinical results with isolation perfusion, and discuss the potential future clinical use of these approaches.