Hypoxic Perfusion With Mitomycin-C In The Treatment Of Multifocal Liver Metastases And Primary Tumors: A Mono-Institutional Series Of 42 Patients.

e14100 Background: Local-regional (L-R) treatments are utilized in chemoresistant liver metastases or primary tumors not amenable to surgery. In patients with multifocal metastases we modified this approach by inducing a stop-flow of the hepatic artery by an angiographic balloon-catheter, followed by infusion of MMC and by embolization of the arterial vascular supply of the tumor with a gelatine sponge. This hypoxic perfusion with MMC combines the hypoxia effect, which improves the cytotoxic activity of MMC, and the ischemic damage induced by the embolization, with the advantage of targeting the whole liver and to reach also small, peripheral lesions. Methods: Forty-two patients, all refractory to L-R and to systemic treatments, were treated with hypoxic perfusion with MMC from June 2001 to May 2009 (56 total procedures). Main patient characteristics are seen in the Table. Results: Patients remained in–hospital for median 10 days (range 7-15). Side effects associated with the procedure were: liver toxicity (median CTCAE grade 2), 1 acute pancreatitis (CTCAE grade 4), 1 liver failure (CTCAE grade 5). At a 30-day follow-up CT scan, PR was observed in 29% of patients, SD in 45%, and PD in 26%. Response had a 4 month-median duration (range 3-6). Median OS from disease relapse for all patients was 20 months, and 30 months for patients with colorectal cancer. Conclusions: The procedure is feasible, with an acceptable toxicity and treatment-associated mortality. Better patient selection can further improve results. Median age (range) 57 (33-78) M/F 25/17 Median ECOG score (range) 1 (0-2) Previous L-R treatments, including surgery 60% Previous systemic treatments (range) 2 (1-3) Primary tumors: No. of patients (%) Colangiocarcinoma 6 (14) Metastatic tumors: Colorectal 25 (60) Pancreas 3 (7) Neuroendocrine tumors 2 (5) Uveal melanoma 2 (5) Gastric 2 (5) Ovarian 1 (2.3) Fibrosarcoma 1 (2.3) No significant financial relationships to disclose.