Isolated and percutaneous liver perfusion for unresectable metastatic liver tumors: a systematic review.

Abstract

Background: Background: Liver metastases may be difficultly to manage by operative or ablative therapy. Isolated hepatic perfusion (IHP) and its alternative, Percutaneous Hepatic Perfusion (PHP), is a regional therapy which allows the delivery of high doses of chemotherapeutic agents and at the same time systemic toxicity is avoided. We conducted a systematic review of the literature in order to evaluate the efficacy of IHP or PHP on tumor response rates and overall survival. Methods: Methods: MEDLINE (1950 to 2011), EMBASE (1980 to 2011), and the Cochrane Library were searched to identify studies of outcomes in patients submitted to IHP or PHP for unresectable metastatic liver disease. Cohort studies that matched our inclusion criteria and reported the outcomes following the procedure were included. The MOOSE guidelines were used as a basis for this review. Results: Results: Sixteen studies met the inclusion criteria. Case-control studies resulted to conflicting results compared IHP with systemic chemotherapy regarded overall response rate and overall survival.Severe complications and especially hepatotoxicity where reported, which in some studies reached up to 65%. Although PHP resulted in less hepatotoxicity events, was associated with high rates of myelotoxicity. Conclusion: Conclusions: IHP has showed some encouraging Results, although the morbidity of the procedure is relatively high. Currently there is not enough good evidence that IHP better than systemic chemotherapy.