The Effect of Perfusate Buffering on Toxicity and Response in Isolated Hepatic Perfusion for Uveal Melanoma Liver Metastases.

Isolated hepatic perfusion (IHP) is a treatment option for patients with liver metastases. Previous studies have found that liver toxicity is one of the limiting factors, and in an attempt to reduce the toxicity a buffering agent was added to the perfusate. The aim was to retrospectively analyze if this buffering reduced toxicity and complication rates.

A retrospective review of 52 consecutive patients with uveal melanoma liver metastases treated with IHP between 2005-2013. Patients were followed by daily liver function tests (LFT). Toxicity was graded according to CTCAE 4.0, complications according to Clavien-Dindo and response according to RECIST-criteria.

Thirty-six patients were treated with a buffered perfusate and 16 patients without buffer. There was no difference in age, gender, largest tumor size or number of tumors between the groups. There was a significantly lower mean in peak ALT, AST, PK (INR) and bilirubin when comparing buffer with no-buffer. There were five major complications without a significant difference between the groups (8.3% vs. 12.5%, p = 0.33). There was a lower complete response rate (11% vs 44%, p = 0.023) and a trend for shorter time to local progression (9.2 vs. 17.6 months, p = 0.096), however not significant in multivariate analysis. There was no difference in survival (24.2 vs. 26.0 months, p = 0.43) between the two groups.

Adding buffer to the perfusate during IHP significantly reduces postoperative LFTs, however without a reduced complication rate. Interestingly, buffering also seems to reduce the response rate, however this did not translate into a survival difference. To address if buffering adds any clinical benefit to the patients concerning toxicity, a larger prospective trial is necessary.

International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. 2017 Jan 22 [Epub ahead of print]

Ilan Ben-Shabat, Valerio Belgrano, Christoffer Hansson, Roger Olofsson Bagge

a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden., b Department of Thoracic Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.