Hepatic artery infusion pump for nasopharyngeal carcinoma with liver metastasis

Haiping Li,Changli Peng,Gang Li,Chunhui Zhou,Liangrong Shi

doi:10.1007/s10585-019-10015-0

Abstract

To evaluate the benefits and risks of hepatic artery infusion (HAI) gemcitabine and floxuridine (FUDR) in patients with nasopharyngeal carcinoma liver metastases. HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 16 patients with unresectable nasopharyngeal carcinoma liver metastases. HAI gemcitabine and FUDR in combination with radiotherapy and systemic chemotherapy were delivered. Disease control rate (DCR) of intrahepatic lesions is 100%, objective response rate (ORR) of intrahepatic lesions is 87.5%, including 4 patients (25%) with complete response (CR), 10 patients (62.5%) with partial response (PR) and 2 patients (12.5%) with stable disease (SD). The median overall survival (mOS) was 30 months. There was no significant difference between patients with < 9 intrahepatic lesions and patients with ≥ 9 intrahepatic lesions (31 months vs. 24 months, P = 0.562). Patients without extrahepatic metastases has longer survival than patients with extrahepatic metastases (31 months vs. 17 months, P = 0.005). In all 72 cycles of HAI, the main grade 3/4 toxicities related to HAI include: leukopenia occur in 8 cycles (11.1%), thrombocytopenia in 5 cycles (6.9%), AST/ALT elevation in 12 cycles (16.7). Catheter related complications occurred in 2 patients (12.5%). HAI gemcitabine and FUDR is effective to improve DCR of intrahepatic lesions and prolong mOS for patients with nasopharyngeal carcinoma liver metastases, and is associated with a relative low rate of toxicity.

Highlights

Nasopharyngeal carcinoma (NPC) is a common head and neck malignancy, with a high prevalence in South-East Asia, in southern China [1]
Previous work by our team showed that initial hepatic artery infusion (HAI) and systemic chemotherapy is helpful for colorectal cancer patients with liver metastases to obtain a high resection rate [10]
Several studies have been shown that HAI is effective in improving hepatic response rates in colorectal cancer liver metastasis

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a common head and neck malignancy, with a high prevalence in South-East Asia, in southern China [1]. Unlike other head and neck cancers, NPC presents with high incidence of locoregional recurrence or distant metastases [3], which is considered as the predominant cause of mortality [4]. Previous work by our team showed that initial hepatic artery infusion (HAI) and systemic chemotherapy is helpful for colorectal cancer patients with liver metastases to obtain a high resection rate [10]. Hepatic-directed therapy is recommended for some liver-predominant disease in patients with neuroendocrine tumors of the pancreas [11]. We use this HAI regime in NPC patients with liver-predominant metastases, aiming to verify its effectiveness and safety

Methods

Results

Conclusion