BACKGROUND: Many treatments have been proposed for non-resectable primary or secondary hepatic cancer but the results have been disappointing. Isolated hepatic perfusion (IHP) was attempted five decades ago but it has...BACKGROUND: Many treatments have been proposed for non-resectable primary or secondary hepatic cancer but the results have been disappointing. Isolated hepatic perfusion (IHP) was attempted five decades ago but it has been ac- cepted recently after spectacular tumour responses were ob- tained by several phase trials. DATA SOURCES: An English-language literature search using MEDLINE (2003), Index Medicus (2003) and biblio- graphic reviews of books and review articles. IHP and its history and recent clinical application. RESULTS: IHP offers unique pharmacokinetic advantages for locoregional chemotherapy and biotherapy. Surgical isolation of the liver and percutaneous techniques using bal- loon occlusion catheters are reliable and safe. They appear to have significant efficacy even in patients with advanced tumor burden or those with tumors refractory to other types of therapy. CONCLUSION: IHP which has been developed in recent years is becoming a promising strategy for the treatment of unresectable liver cancer.展开更多
AIMTo investigate the effcacy and safety of isolated hepatic perfusion （IHP） in the management of unresectable liver malignancies.METHODSStudies were identified manually and on-line by using PubMed and EMBASE databa...AIMTo investigate the effcacy and safety of isolated hepatic perfusion （IHP） in the management of unresectable liver malignancies.METHODSStudies were identified manually and on-line by using PubMed and EMBASE database. We formulate the eligibility criteria according to the PICOS elements, and accessed the quality of studies using the MINORS instrument. Data from all included studies were carefully investigated. We calculated the pooled response rate and incidences of mortality reported from all eligible studiesby using the Meta-Analyst software, and we computed a pooled relative risk （RR） and 95%CI by using the Comprehensive Meta-Analysis software. Heterogeneity was quantifed evaluated using I2 statistic.RESULTS Eight studies, including 502 patients, were selected. Of these, six studies performed IHP, while the other two studies performed percutaneous IHP. The results showed that the pooled response rate was 60.8% （95%CI： 53.1%-68%）, I2 = 37.1%. The median overall survival was 20 mo （range： 12.1 to 25 mo） following IHP or PIHP. The pooled mortality rate was 5.4% （95%CI： 2.5%-11.2%）, I2 = 37.5%. Prognostic factors predict the response to IHP or survival, and were reported in six studies. Meta-analysis demonstrated that Gender was not associated with overall survival （RR = 0.877, 95%CI： 0.564-1.365）; however, carcino-embryonic antigen ≤ 30 ng/mL was associated with a signifcant improvement in survival outcomes with colorectal cancer patients （RR = 2.082, 95%CI： 1.371-3.163）, and there was no signifcant heterogeneity.CONCLUSIONThe present systemic review and meta-analysis suggest that IHP and PIHP are potentially efficient and safe techniques for unresectable liver primary and secondarymalignancies.展开更多
文摘BACKGROUND: Many treatments have been proposed for non-resectable primary or secondary hepatic cancer but the results have been disappointing. Isolated hepatic perfusion (IHP) was attempted five decades ago but it has been ac- cepted recently after spectacular tumour responses were ob- tained by several phase trials. DATA SOURCES: An English-language literature search using MEDLINE (2003), Index Medicus (2003) and biblio- graphic reviews of books and review articles. IHP and its history and recent clinical application. RESULTS: IHP offers unique pharmacokinetic advantages for locoregional chemotherapy and biotherapy. Surgical isolation of the liver and percutaneous techniques using bal- loon occlusion catheters are reliable and safe. They appear to have significant efficacy even in patients with advanced tumor burden or those with tumors refractory to other types of therapy. CONCLUSION: IHP which has been developed in recent years is becoming a promising strategy for the treatment of unresectable liver cancer.
文摘AIMTo investigate the effcacy and safety of isolated hepatic perfusion （IHP） in the management of unresectable liver malignancies.METHODSStudies were identified manually and on-line by using PubMed and EMBASE database. We formulate the eligibility criteria according to the PICOS elements, and accessed the quality of studies using the MINORS instrument. Data from all included studies were carefully investigated. We calculated the pooled response rate and incidences of mortality reported from all eligible studiesby using the Meta-Analyst software, and we computed a pooled relative risk （RR） and 95%CI by using the Comprehensive Meta-Analysis software. Heterogeneity was quantifed evaluated using I2 statistic.RESULTS Eight studies, including 502 patients, were selected. Of these, six studies performed IHP, while the other two studies performed percutaneous IHP. The results showed that the pooled response rate was 60.8% （95%CI： 53.1%-68%）, I2 = 37.1%. The median overall survival was 20 mo （range： 12.1 to 25 mo） following IHP or PIHP. The pooled mortality rate was 5.4% （95%CI： 2.5%-11.2%）, I2 = 37.5%. Prognostic factors predict the response to IHP or survival, and were reported in six studies. Meta-analysis demonstrated that Gender was not associated with overall survival （RR = 0.877, 95%CI： 0.564-1.365）; however, carcino-embryonic antigen ≤ 30 ng/mL was associated with a signifcant improvement in survival outcomes with colorectal cancer patients （RR = 2.082, 95%CI： 1.371-3.163）, and there was no signifcant heterogeneity.CONCLUSIONThe present systemic review and meta-analysis suggest that IHP and PIHP are potentially efficient and safe techniques for unresectable liver primary and secondarymalignancies.
