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Review

Percutaneous hepatic perfusion with melphalan for

unresectable liver metastasis

1
1
1
2
Humair S. Quadri , Eden C. Payabyab , David J. Chen , William Figg ,
Marybeth S. Hughes 1
1 Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
2 Genitourinary Malignancies Branch, National Cancer Institute, Bethesda, MD 20892, USA.

Humair S. Quadri, M.D., is a general surgery resident at Georgetown University Hospital in Washington,
D.C. who completed a two year surgical oncology fellowship at the National Cancer Institute of the National
Institutes of Health in Bethesda, Maryland. He received his M.D. from Georgetown University School of
Medicine in Washington, D.C.

ABSTRACT
Percutaneous hepatic perfusion (PHP) is an investigative technique for treating patients with diffuse unresectable metastatic
liver disease. The technique has been clinically evaluated and shows great treatment potential for regional therapy to the
liver. The advantage of PHP lies in its minimally invasive approach and ability to be repeated when compared to isolated
hepatic perfusion. In a literature search, 135 publications were screened and 16 of these publications, including clinical
trials and reviews, contributed to this review of PHP with melphalan. Melphalan is an alkylating agent that, when used
as the chemotherapeutic agent in PHP, has shown potential for significant control of tumor burden in the liver, especially
in metastatic ocular melanoma. In the current landscape of liver directed therapy, PHP is a viable option for those with
unresectable metastatic disease to the liver. This article will focus on the technical aspects of PHP and describe the current
data available from clinical trials, including outcomes of patients treated with this minimally invasive approach.
Key words: Percutaneous hepatic perfusion; melphalan; unresectable liver metastasis; metastatic melanoma to the liver;
ocular melanoma

Corresponding Author:
Dr. Marybeth S. Hughes, Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Room 4-5940, Building 10 - Hatfield CRC,
Bethesda, MD 20892, USA. E-mail: hughesm@mail.nih.gov
Received: 24-06-2016；Accepted: 28-06-2016

INTRODUCTION considered unresectable due to excessive tumor burden,
tumor location, effect on inflow or outflow, an insufficient
What is percutaneous hepatic perfusion liver remnant, or a significant comorbidity. Most patients
[2]
The treatment of metastatic disease to the liver is an with liver-only unresectable metastatic disease have options
evolving paradigm that has been evaluated with increasing of directed treatment. Percutaneous hepatic perfusion (PHP)
potential over the past few decades. Though there are is one of these novel techniques for patients with diffuse
treatment options for solitary or localized liver lesions, liver-only metastatic disease.
there is no treatment consensus when multiple metastatic
lesions are found throughout the liver. It is estimated PHP is a minimally invasive procedure which allows for
[1]
that approximately 80% of people with liver metastasis are
regional therapy to the liver. Arterial cannulation of the
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DOI: How to cite this article: Quadri HS, Payabyab EC, Chen DJ, Figg
10.20517/2394-5079.2016.24 W, Hughes MS. Percutaneous hepatic perfusion with melphalan for
unresectable liver metastasis. Hepatoma Res 2016;2:197-202.
© 2016 Hepatoma Research | Published by OAE Publishing Inc. 197