Hala Muaddi1, Michael D'Angelica2, Jason T Wiseman3, Mary Dillhoff3, Nicholas Latchana4, Rachel Roke1, Yoo-Joung Ko1,5, Darren Carpizo6, Kristen Spencer7, Ryan C Fields8, Gregory Williams8, Federico Aucejo9, Lou-Anne Acevedo-Moreno9, Kevin G Billingsley10, Brett S Walker10, Skye C Mayo10, Paul J Karanicolas1. 1. Division of General Surgery, Sunnybrook Health Science Centre, Toronto, Ontario, Canada. 2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 3. Arthur G. James Comprehensive Cancer Center Cancer Cachexia Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 4. Department of Surgery, Novant Health Carolina Surgical, Charlotte, North Carolina, USA. 5. St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Department of Surgery, Division of Surgical Oncology, Rochester's School of Medicine and Dentistry and Wilmot Cancer Center, Rochester, New York, USA. 7. Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA. 8. Department of Surgery, Washington University School of Medicine and the Alvin J. Siteman Comprehensive Cancer Center, St. Louis, Missouri, USA. 9. Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA. 10. Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University Knight Cancer Institute, Portland, Oregon, USA.
Abstract
INTRODUCTION: Hepatic artery infusion pump (HAIP) chemotherapy is a specialized therapy for patients with unresectable colorectal liver metastases (uCRLM). Its effectiveness was demonstrated from a high volume center, with uncertainty regarding the feasibility and safety at other centers. Therefore, we sought to assess the safety and feasibility of HAIP for the management of uCRLM at other centers. METHODS: We conducted a multicenter retrospective cohort study of patients with uCRLM treated with HAIP from January 2003 to December 2017 at six North American centers initiating the HAIP program. Outcomes included the safety and feasibility of HAIP chemotherapy. RESULTS: We identified 154 patients with HAIP insertion and the median age of 54 (48-61) years. The burden of disease was >10 intra-hepatic metastatic foci in 59 (38.3%) patients. Patients received at least one cycle of systemic chemotherapy before HAIP insertion. Major complications occurred in 7 (4.6%) patients during their hospitalization and 13 (8.4%) patients developed biliary sclerosis during follow-up. A total of 148 patients (96.1%) received at least one-dose of HAIP chemotherapy with a median of 5 (4-7) cycles. 78 patients (56.5%) had a complete or partial response and 12 (7.8%) received a curative liver resection. CONCLUSION: HAIP programs can be safely and effectively initiated in previously inexperienced centers with good response.
INTRODUCTION: Hepatic artery infusion pump (HAIP) chemotherapy is a specialized therapy for patients with unresectable colorectal liver metastases (uCRLM). Its effectiveness was demonstrated from a high volume center, with uncertainty regarding the feasibility and safety at other centers. Therefore, we sought to assess the safety and feasibility of HAIP for the management of uCRLM at other centers. METHODS: We conducted a multicenter retrospective cohort study of patients with uCRLM treated with HAIP from January 2003 to December 2017 at six North American centers initiating the HAIP program. Outcomes included the safety and feasibility of HAIP chemotherapy. RESULTS: We identified 154 patients with HAIP insertion and the median age of 54 (48-61) years. The burden of disease was >10 intra-hepatic metastatic foci in 59 (38.3%) patients. Patients received at least one cycle of systemic chemotherapy before HAIP insertion. Major complications occurred in 7 (4.6%) patients during their hospitalization and 13 (8.4%) patients developed biliary sclerosis during follow-up. A total of 148 patients (96.1%) received at least one-dose of HAIP chemotherapy with a median of 5 (4-7) cycles. 78 patients (56.5%) had a complete or partial response and 12 (7.8%) received a curative liver resection. CONCLUSION: HAIP programs can be safely and effectively initiated in previously inexperienced centers with good response.
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