Percutaneous isolated hepatic perfusion (chemosaturation) with melphalan following right hemihepatectomy in patients wit
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RESEARCH PAPER
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 C. L. A. Dewald1 · L. S. Becker1 · S. K. Maschke1 · T. C. Meine1 · T. A. Alten1 · M. M. Kirstein2 · A. Vogel2 · F. K. Wacker1 · B. C. Meyer1 · J. B. Hinrichs1 Received: 13 August 2020 / Accepted: 25 September 2020 © The Author(s) 2020
Abstract To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 (1–5; mild-death). Significance was tested using Wilcoxon signed-rank and Mann–Whitney U test. Kaplan–Meier estimation and log-rank test assessed survival. Overall 21 CS-PHP in seven patients (4/7 males; 52 ± 10 years) with hemihepatectomy (grouphemihep) and 22 CS-PHP in seven patients (3/7 males; 63 ± 12 years) without prior surgery ( groupnoresection) were included. No complications occurred during the CS-PHP procedures. Transient changes (CTCAE grade 1–2) of liver enzymes and blood cells followed all procedures. In comparison, g rouphemihep presented slightly more AEs grade 3–4 (e.g. thrombocytopenia in 57% (12/21) vs. 41% (9/22; p = 0.37)) 5–7 days after CS-PHP. These AEs were self-limiting or responsive to treatment (insignificant difference of pre-interventional to 21–45 days post-interventional values (p > 0.05)). One patient in grouphemihep with high tumor burden died eight days following CS-PHP. No deaths occurred in groupnoresection. In comparison, overall survival after first diagnosis was insignificantly shorter in groupnoresection (44.7(32–56.1) months) than in grouphemihep (48.3(34.6–72.8) months; p = 0.48). The severity of adverse events following CS-PHP in patients after hemihepatectomy was comparable to a matched group without prior liver surgery. Thus, the performance of CS-PHP is not substantially compromised by a prior hemihepatectomy. Keywords Chemosaturation · Hemihepatectomy · Melphalan · Metastatic uveal melanoma · Cholangiocarcinoma · Percutaneous locoregional therapy Abbreviations AE Adverse event BAC Best available care CS-PHP Chemosaturation percutaneous hepatic perfusion
* J. B. Hinrichs hinrichs.jan@mh‑hannover.de Extended author information available on the last page of the article
CTCAE Common terminology criteria for adverse events ECOG E
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