Download PDF
Rofo 2023; 195(01): 30-37
DOI: 10.1055/a-1858-3418
Interventional Radiology

Chemosaturation der Leber – ein Update

Article in several languages: English | deutsch
Sebastian Ebel 
1   Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
,
Manuel Florian Struck 
2   Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Leipzig University, Leipzig, Germany
,
Florian van Boemmel
3   Klinik für Innere Medizin II, Sektion für Hepatologie, Leipzig University, Leipzig, Germany
,
Anne Bettina Beeskow
1   Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
,
Holger Gößmann
1   Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
,
Timm Denecke
1   Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Leipzig University, Leipzig, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Zusammenfassung

Hintergrund Die Chemosaturation der Leber („percutaneus hepatic perfusion“, CS-PHP) ist eine Behandlungsoption für primäre und sekundäre Lebertumore und aktuell Gegenstand intensiver Forschung. Der vorliegende Artikel soll eine Übersicht über Patientensicherheit, Durchführung und Wirksamkeit der CS-PHP auf Basis des aktuellen Forschungsstandes geben.

Methode Es wurde eine Literaturrecherche in Pubmed mit den Stichwörtern chemosaturation, hepatic chemosaturation, percutaneous hepatic perfusion, und melphalan durchgeführt.

Ergebnisse und Schlussfolgerungen Die CS-PHP stellt ein potentes Verfahren zur Behandlung von hepatisch metastasierten okulären Melanomen und intrahepatischen cholangiozellulären Karzinomen dar. Bezüglich anderer Tumorentitäten ist die Datenlage nicht ausreichend um eine fundierte Aussage treffen zu können. Chemosaturationen können mit vielfältigen Komplikationen und Nebenwirkungen einhergehen, welche jedoch überwiegend vorübergehend bzw. interdisziplinär beherrschbar sind.

Kernaussagen 

  • Die Chemosaturation der Leber (CS-PHP) ist ein sicheres Verfahren.

  • CS-PHP ist ein potentes Verfahren zur Therapie von hepatisch metastasierten okulären Melanomen und cholangiozellulären Karzinomen.

  • Die Durchführung erfordert eine enge interdisziplinäre Kooperation.

  • Die CS-PHP ist wiederholbar und ist daher möglicherweise eine Langzeit-Therapieoption für einige Patienten.

Zitierweise

  • Ebel S, Struck MF, van Boemmel F et al. Chemosaturation of the Liver – an Update. Fortschr Röntgenstr 2023; 195: 30 – 37

Key words

abdomen - hematologic - angiography - interventional procedures


Publication History

Received: 20 September 2021

Accepted: 05 May 2022

Article published online:
17 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Inc D Hepatic Delivery System Instructions for Use.
    PubMed
  • 2 Meijer TS, Burgmans MC, Fiocco M. et al. Safety of Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Liver Metastases from Ocular Melanoma Using the Delcath Systems’ Second-Generation Hemofiltration System: A Prospective Non-randomized Phase II Trial. Cardiovasc Intervent Radiol 2019; 42: 841-852
    CrossrefPubMedSearch in Google Scholar
  • 3 Dewald CLA, Meine TC, Winther HMB. et al. Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter. Cardiovasc Intervent Radiol 2019; 42: 1441-1448
    CrossrefPubMedSearch in Google Scholar
  • 4 Dewald CLA, Becker LS, Maschke SK. et al. Percutaneous isolated hepatic perfusion (chemosaturation) with melphalan following right hemihepatectomy in patients with cholangiocarcinoma and metastatic uveal melanoma: peri- and post-interventional adverse events and therapy response compared to a matched group without prior liver surgery. Clin Exp Metastasis 2020; 37: 683-692
    CrossrefPubMedSearch in Google Scholar
  • 5 Struck MF, Kliem P, Ebel S. et al. Percutaneous hepatic melphalan perfusion: Single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery. PLoS One 2021; 16
    CrossrefPubMedSearch in Google Scholar
  • 6 de Leede EM, Burgmans MC, Meijer TS. et al. Prospective Clinical and Pharmacological Evaluation of the Delcath System’s Second-Generation (GEN2) Hemofiltration System in Patients Undergoing Percutaneous Hepatic Perfusion with Melphalan. Cardiovasc Intervent Radiol 2017; 40: 1196-1205
    CrossrefPubMedSearch in Google Scholar
  • 7 Forster MR, Rashid OM, Perez MC. et al. Chemosaturation with percutaneous hepatic perfusion for unresectable metastatic melanoma or sarcoma to the liver: A single institution experience. J Surg Oncol 2014; 109: 434-439
    CrossrefPubMedSearch in Google Scholar
  • 8 Dewald CLA, Hinrichs JB, Becker LS. et al. Chemosaturation with Percutaneous Hepatic Perfusion: Outcome and Safety in Patients with Metastasized Uveal Melanoma. RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der Bildgeb Verfahren 2021; 193: 928-936
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Karydis I, Gangi A, Wheater MJ. et al. Percutaneous hepatic perfusion with melphalan in uveal melanoma: A safe and effective treatment modality in an orphan disease. J Surg Oncol 2018; 117: 1170-1178
    CrossrefPubMedSearch in Google Scholar
  • 10 Marquardt S, Kirstein MM, Brüning R. et al. Percutaneous hepatic perfusion (chemosaturation) with melphalan in patients with intrahepatic cholangiocarcinoma: European multicentre study on safety, short-term effects and survival. Eur Radiol 2019; 29: 1882-1892
    CrossrefPubMedSearch in Google Scholar
  • 11 Vogl TJ, Koch SA, Lotz G. et al. Percutaneous Isolated Hepatic Perfusion as a Treatment for Isolated Hepatic Metastases of Uveal Melanoma: Patient Outcome and Safety in a Multi-centre Study. Cardiovasc Intervent Radiol 2017; 40: 864-872
    CrossrefPubMedSearch in Google Scholar
  • 12 Brüning R, Tiede M, Schneider M. et al. Unresectable Hepatic Metastasis of Uveal Melanoma: Hepatic Chemosaturation with High-Dose Melphalan – Long-Term Overall Survival Negatively Correlates with Tumor Burden. Radiol Res Pract 2020; 2020: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 13 Schönfeld L, Hinrichs JB, Marquardt S. et al. Chemosaturation with percutaneous hepatic perfusion is effective in patients with ocular melanoma and cholangiocarcinoma. J Cancer Res Clin Oncol 2020; 146: 3003-3012
    CrossrefPubMedSearch in Google Scholar
  • 14 Vogl TJ, Zangos S, Scholtz JE. et al. Chemosaturation with percutaneous hepatic perfusions of melphalan for hepatic metastases: experience from two European centers. Rofo 2014; 186: 937-944
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Artzner C, Mossakowski O, Hefferman G. et al. Chemosaturation with percutaneous hepatic perfusion of melphalan for liver-dominant metastatic uveal melanoma: A single center experience. Cancer Imaging 2019; 19: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 16 Hughes MS, Zager J, Faries M. et al. Results of a Randomized Controlled Multicenter Phase III Trial of Percutaneous Hepatic Perfusion Compared with Best Available Care for Patients with Melanoma Liver Metastases. Ann Surg Oncol 2016; 23: 1309-1319
    CrossrefPubMedSearch in Google Scholar
  • 17 Pingpank JF, Libutti SK, Chang R. et al. Phase I Study of Hepatic Arterial Melphalan Infusion and Hepatic Venous Hemofiltration Using Percutaneously Placed Catheters in Patients With Unresectable Hepatic Malignancies. J Clin Oncol 2008; 23: 3465-3474
    CrossrefPubMedSearch in Google Scholar
  • 18 Kirstein MM, Marquardt S, Jedicke N. et al. Safety and efficacy of chemosaturation in patients with primary and secondary liver tumors. J Cancer Res Clin Oncol 2017; 143: 2113-2121
    CrossrefPubMedSearch in Google Scholar
  • 19 Carr MJ, Sun J, Cohen JB. et al. Over 12 Years Single Institutional Experience Performing Percutaneous Hepatic Perfusion for Unresectable Liver Metastases. Cancer Control 2020; 27: 1-9
    CrossrefPubMedSearch in Google Scholar
  • 20 Ferrucci PF, Cocorocchio E, Bonomo G. et al. A New Option for the Treatment of Intrahepatic Cholangiocarcinoma: Percutaneous Hepatic Perfusion with CHEMOSAT Delivery System. Cells 2021; 10
    CrossrefPubMedSearch in Google Scholar
  • 21 Onkologie L. S3-Leitlinie Früherkennung, Therapie und Nachsorge des Melanomes. 2020: 1-400
    PubMedSearch in Google Scholar
  • 22 Feldman ED, Pingpank JF, Alexander HR. Regional treatment options for patients with ocular melanoma metastatic to the liver. Ann Surg Oncol 2004; 11: 290-297
    CrossrefPubMedSearch in Google Scholar
  • 23 Jovanovic P, Mihajlovic M, Djordjevic-Jocic J. et al. Ocular melanoma: An overview of the current status. Int J Clin Exp Pathol 2013; 6: 1230-1244
    PubMedSearch in Google Scholar
  • 24 Gragoudas ES, Egan KM, Seddon JM. et al. Survival of Patents with Metastases from Uveal Melanoma. Ophthalmology 1991; 98: 383-390
    CrossrefPubMedSearch in Google Scholar
  • 25 Carvajal RD, Schwartz GK, Tezel T. et al. Metastatic disease from uveal melanoma: Treatment options and future prospects. Br J Ophthalmol 2017; 101: 38-44
    CrossrefPubMedSearch in Google Scholar
  • 26 Hawkins BS. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol 2006; 124: 1684-1693
    CrossrefPubMedSearch in Google Scholar
  • 27 Triozzi PL, Singh AD. Adjuvant Therapy of Uveal Melanoma: Current Status. Ocul Oncol Pathol 2015; 1: 54-62
    CrossrefPubMedSearch in Google Scholar
  • 28 Khoja L, Atenafu EG, Joshua AM. Meta-analysis of phase II trials in metastatic uveal melanoma (MUM) to determine progression-free (PFS) and overall survival (OS) benchmarks for future phase II trials: An irci-ocular melanoma initiative. J Clin Oncol 2016; 34: 9567
    CrossrefPubMedSearch in Google Scholar
  • 29 Xing M, Prajapati HJ, Dhanasekaran R. et al. Selective internal yttrium-90 radioembolization therapy (90Y-SIRT) versus best supportive care in patients with unresectable metastatic melanoma to the liver refractory to systemic therapy. Am J Clin Oncol 2017; 40: 27-34
    CrossrefPubMedSearch in Google Scholar
  • 30 Memon K, Kuzel TM, Vouche M. et al. Hepatic yttrium-90 radioembolization for metastatic melanoma: A single-center experience. Melanoma Res 2014; 24: 244-251
    CrossrefPubMedSearch in Google Scholar
  • 31 Gupta S, Bedikian AY, Ahrar J. et al. Hepatic artery chemoembolization in patients with ocular melanoma metastatic to the liver: Response, survival, and prognostic factors. Am J Clin Oncol Cancer Clin Trials 2010; 33: 474-480
    CrossrefPubMedSearch in Google Scholar
  • 32 Ahrar J, Gupta S, Ensor J. et al. Response, survival, and prognostic factors after hepatic arterial chemoembolization in patients with liver metastases from cutaneous melanoma. Cancer Invest 2011; 29: 49-55
    CrossrefPubMedSearch in Google Scholar
  • 33 Gonsalves CF, Eschelman DJ, Adamo RD. et al. A prospective Phase II trial of radioembolization for treatment of uveal melanoma hepatic metastasis. Radiology 2019; 293: 223-231
    CrossrefPubMedSearch in Google Scholar
  • 34 Veelken R, Maiwald B, Strocka S. et al Repeated percutaneous hepatic perfusion with melphalan can maintain long-term response in patients with liver cancers. Cardiovasc Intervent Radiol In Press 2021
    PubMedSearch in Google Scholar
  • 35 Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: Epidemiology and risk factors. Liver Int 2019; 39: 19-31
    CrossrefPubMedSearch in Google Scholar
  • 36 Benson AB, D’Angelica MI, Abbott DE. et al. Hepatobiliary cancers, Version 2.2021. JNCCN J Natl Compr Cancer Netw 2021; 19: 541-565
    CrossrefPubMedSearch in Google Scholar
  • 37 Rizvi S, Khan SA, Hallemeier CL. et al. Cholangiocarcinoma – evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 2018; 15: 95-111
    CrossrefPubMedSearch in Google Scholar
  • 38 Weber SM, Jarnagin WR, Klimstra D. et al. Intrahepatic Cholangiocarcinoma: resectability, recurrence pattern, and outcomes1 1No competing interests declared. J Am Coll Surg 2001; 193: 384-391
    CrossrefPubMedSearch in Google Scholar
  • 39 Jarnagin WR, Fong Y, DeMatteo RP. et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001; 234: 507-519
    CrossrefPubMedSearch in Google Scholar
  • 40 Bridgewater J, Galle PR, Khan SA. et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60: 1268-1289
    CrossrefPubMedSearch in Google Scholar
  • 41 Onkologie L. Konsultationsfassung Diagnostik und Therapie des Hepatozellulären Karzinoms und biliärer Karzinome Wesentliche Neuerungen in der Leitlinie zur Diagnostik und Therapie des hepatozellulären Karzinoms. 2021: 1-205
    PubMedSearch in Google Scholar
  • 42 Akateh C, Ejaz AM, Pawlik TM. et al. Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma. World J Hepatol 2020; 12: 693-708
    CrossrefPubMedSearch in Google Scholar
  • 43 Pingpank JF, Hughes MS, Alexander HR. et al. A phase III random assignment trial comparing percutaneous hepatic perfusion with melphalan (PHP-mel) to standard of care for patients with hepatic metastases from metastatic ocular or cutaneous melanoma. J Clin Oncol 2010; 28: LBA8512-LBA8512
    CrossrefPubMedSearch in Google Scholar
  • 44 Estler A, Artzner C, Nikolaou K. et al. Vorhersage des Tumoransprechens und Gesamtüberleben nach Chemosaturation bei hepatisch metastasiertem Aderhautmelanom. RöFo – Fortschritte auf dem Gebiet der Röntgenstrahlen und der Bildgeb Verfahren 2021; 1: 10
    PubMedSearch in Google Scholar