Hepatic Artery Infusion Therapy: The European Experience

In Europe, the placement of hepatic artery ports in interventional radiology has facilitated the development of hepatic artery infusion (HAI) of chemotherapy. HAI of chemotherapy represents an effective option to downsize liver metastases from colorectal cancer, and enables curative intent hepatectomies in patients with previously unresectable liver metastases, with overall median survival of about 3 years. Multidrug chemotherapy protocols combining various modalities of hepatic artery and venous infusions are effective, even in cases of prior progression on systemic-only chemotherapy with the same drugs. However, outcomes are the best among patients receiving HAI chemotherapy as the first or second line. Thus, the conversion-to-resection rates are 29–46% for those receiving HAI as second line and 13–18% of those receiving HAI as third or later treatment line for metastatic disease, resulting in respective median overall survival, 20–32 months and 11–26 months. Liver pain and catheter occlusions are the main disadvantages of HAI chemotherapy and occur in nearly 25 and 60% of the patients, respectively, while other adverse events appear to depend upon drug extrahepatic levels. Despite high response rates, chemoembolization, including techniques using novel vectors such as DC Beads, has yielded less convincing overall results.