Hepatic Arterial Infusion (HAI)

Patient Selection Criteria

Hepatic Arterial infusion is an option for patients with metastatic colon cancer. It is rarely offered to patients with primary liver cancer or metastasis from other cancers except the colon, because there are no extensive studies on its effectiveness.

Description of Procedure

Hepatic Arterial Infusion (HAI) therapy is the delivery of chemotherapeutic agents to the liver through a catheter placed in the hepatic artery. This is most often done in the operating room with general anesthesia and an open procedure. A pump is implanted percutaneously (under the skin) for delivery of chemotherapy. The type and the schedule of chemotherapy delivered via the pump will depend on the physician. Generally, the pump is filled with chemotherapy once a month. Body temperature and the mechanism of the pump allow chemotherapy to be delivered continuously at a slow rate directly to the liver. The physician may choose to also give systemic chemotherapy in conjunction with HAI.

Risks/Side Effects/Complications

Complications that can occur with implanting of the pump are similar to the complications of surgery, such as infection, skin erosion over the pump site, and incision breakdown. Because chemotherapy is given via the pump, there is a risk of drug toxicity or drug delivery to organs other than the liver. The most common chemotherapeutic agent given, FUDR, may cause nausea, vomiting, and diarrhea. Overdose or underdose of medication may be a complication if improper handling or filling, strenuous exercise, or contact sports damage the pump. Increased body temperature from fever may also cause delivery of more medication than prescribed.

Recovery Time /Lifestyle Changes

Recovery time generally will last up to three months, the same as the recovery one needs after having surgery. Strenuous activity and heavy lifting should be avoided during this time. Because the amount of drug that is delivered by the pump is dependent on body temperature one should avoid strenuous exercise, saunas, steam baths, hot tubs and heating pads. Low blood pressure may also cause delivery of more medication than prescribed. In turn, high altitudes, mountain climbing and air travel will affect the amount of drug that is delivered.

Effectiveness

There are several advantages to hepatic arterial infusion. HAI is more effective than systemic chemotherapy in the treatment of metastatic colon cancer since higher drug levels are achieved at the sites of metastatic disease. In seven randomized trials, the response rate was higher with HAI compared to systemic therapy. Several studies have been conducted and several studies are undergoing to prove the effectiveness of HAI. One such study conducted at the National Cancer Institute produced response rates in 62% of patients receiving HAI, versus only 17% response with systemic chemotherapy. Of these patients the two-year survival was 47% in the HAI group, verses 13% in the systemic group. HAI clearly is a more effective treatment for metastatic colon cancer than systemic chemotherapy.

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