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Vol. 7, No. 2 2003

results. Hepatic resection continues to be the treatment of choice for this disease. Unfortunatley many patients because of poor liver function or significant co-morbidities are not candidates for hepatic resection. Radiofrequency ablation has become an increasing treatment modality for unresectable hepatic tumors. This study retrospectivley reviews 36 patients with unresectable hepatocellular carcinoma from 8/98 to 9/02. Mean follow up is 25 months (1 to 50 mo) All patients were treated with a cooled-tip cluster radiofrequency probe to achieve tumor margin temperatures of  70C. Patients were treated via percutaneous or operative approaches. 46 lesions were treated in 36 patients. Mean tumor size was 5.3 cm (6 mm to 15 cm). There were two mortalities within 30 days of ablation (CVA, cardiac arrhythmia). Morbidities included 2 patients with hepatic abcess, 2 transient liver dysfunction, 1 hepatic artery to portal venous fistula, and 2 segmental hepatic infarcts. Overall survival was 1 yr 76.7% (23/30), 2 yr 70.6% (12/17), 3 yr 50% (6/12), 4 yr 50% (1/2), 5 yr. NA. Two patients underwent orthotopic liver transplant following ablation with no viable tumor of the explanted specimen. Conclusion: Hepatic radiofrequency ablation is a treatment option which offers improved survival for patients with unresectable hepatocellular carcinoma.

30 Treatment Of Unresectable Primary Hepatic Malignancies Using Hyperthermic Isolated Hepatic Perfusion (IHP). Elizabeth D Feldman, Peter C Wu, Michael X Gnant, David L Bartlett, Steven K Libutti, James F Pingpank Jr, H. Richard Alexander Jr, Surgery Branch, NCI, NIH, Bethesda, MD Background: Primary hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Isolated hepatic perfusion (IHP) is a locoregional treatment technique that isolates the liver in order to deliver high dose chemotherapy, biologic agents, and hyperthermia directly to hepatic parenchyma. This study presents our experience using IHP with melphalan with or without tumor necrosis factor (TNF) to treat nine patients with hepatocellular carcinoma or adenocarcinoma of hepatobiliary origin. Methods: Nine patients with unresectable primary hepatic malignancies underwent a 60-minute IHP with 1.5 mg/kg melphalan with or without 1.0 mg/ kg TNF. Four patients failed one or more previous treatment regimens and the mean hepatic replacement was 41% (range 10-75%). Patients were monitored for response, toxicity, time to recurrence, and survival. Results: Six of nine patients (67%) experienced a 50% regression of tumor on objective radiographic imaging with an additional patient having a 45% reduction in tumor burden. Mean time to recurrence was 6.6 months for those who responded to treatment. Patients who had a response to therapy had an average overall survival of 16.3 months. In five patients hepatic progression was the only sight of disease at death. In three of the remaining four patients, progressive hepatic disease accompanied systemic metastases. A single patient died of progressive pulmonary metastases, without evidence of liver progression. Conclusions: IHP can be performed safely and has significant anti-tumor activity in patients with unresectable primary hepatic malignancies. Hepatic progression continues to be the dominant factor influencing survival in this group of patients.

31 Hepatic Artery Chemoembolization for Isolated Colorectal Metastases to the Liver Paul E Wise, Steve S Liou, Paulgun Sulur, J. K Wright, William C Chapman, Steven G Meranze, Murray J Mazer, C. W Pinson, Vanderbilt University Medical Center, Nashville, TN; Washington University, St. Louis, MO

Abstracts

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Introduction: Surgical resection is the preferred treatment for most hepatic malignancies, but is an option in only 25% of patients due to tumor characteristics or patient comorbidities. Hepatic artery chemoembolization (HACE) is an alternative therapy for these more advanced tumors, but its safety and efficacy for isolated hepatic colorectal metastases (CRM) has not been proven. We reviewed patients with isolated hepatic CRM who underwent HACE at our institution and compared their survival with both surgery for CRM and HACE for other malignancies. Methods: Data evaluated from CRM patients who underwent HACE between 1992 and 1999 included demographics, treatment details, and length of survival (LOS). These survival data were compared to LOS after surgical resection for CRM (n135) as well as LOS after HACE for hepatocellular carcinoma (HCC) (n40) and metastatic carcinoid (n16). These data were analyzed using Kaplan-Meier and log rank methods. Results: Twentythree patients with isolated hepatic CRM having an average age of 59.8  12.1 years (57% male) underwent 44 HACE treatments. Length of hospital stay after HACE ranged from 1-15 days with an average stay of 2.9 days. Minor morbidities (nausea/vomiting, abdominal pain, fever) were reported in 21 patients (91%). Major morbidities included access site hematomas (n3) and neutropenia (n2). There was one mortality secondary to sepsis and multi-system organ failure. LOS after the initial HACE treatment for CRM was significantly shorter than after surgery for CRM (median 9.3 vs. 36.2 months; p0.001). LOS after HACE for CRM was significantly shorter than after HACE for carcinoid (median 9.3 vs. 14.3 months; p0.05), but was equivalent to LOS after HACE for HCC (median 9.3 vs. 7.9 months; n.s.). Conclusions: HACE for CRM is safe and well-tolerated, but survival after HACE was worse than survival after surgical resection for CRM. Results from HACE for CRM are comparable to those for HCC but worse than for carcinoid.

32 Intra-Arterial Yttrium-90 Sir-Spheres for Metastatic Disease to the Liver Riad Salem, Daniel Williams, Vanessa L Gates, Beth Oman, Michelle Beauvais, Jeffrey Margolis, Beaumont Hospital, Royal Oak, MI; Beaumont Hospital, Royal Oak, MI Purpose: To evaluate the safety and efficacy of Yttrium-90 SirSpheres resin for the treatment of metastatic liver disease. Materials and Methods: 24 patients were treated with intra-arterial Yttrium-90 Sir-Spheres. All patients received 2 treatments on a lobar basis at 2835 day intervals. Indications for treatment included metastatic liver cancer from the pancreas (n2), colon (n14), breast (n3), carcinoid (n1) and unknown primary (n4). The average lobar volume was 1163 cc; the average dose of Y90 was 1.1 GBq. Patients had baseline liver function tests, tumor markers, CT and PET scans on or before on the day of treatment. Clinical follow-up, liver functions, CT scans were obtained at 30, as well as PET at 90 days. All patients were off chemotherapy at the time of treatment. Results: 22 of 24 patients received treatment on an outpatient basis and were discharged 6 hours after catheterization. 30 and 90 day clinical, laboratory, and CT follow-up was available in 18 of 24 patients. PET follow-up was available in 16 patients. 21 of 24 (88%) patients complained of fatigue for 7-14 days. 4 patients experienced transient but very severe burning in the area of treatment during the injection of Y90. On CT imaging, 15 of 18 patients had an average decrease in tumor size of 33%. 3 of 18 showed no change on CT. PET showed complete, partial and no response in 7, 7 and 2 patients respectively. Average tumour marker drop (CEA, CA19-9, CA15-3) in the 18 patients was 51% at day 90 following 1st treatment. The patient with carcinoid syndrome had complete resolution of symptoms. Conclusions: SirSpheres hepatic unilobar infusion for metastatic liver disease appears to represent a new and efficacious therapy with mild toxicity in a