Chemotherapy by isolated liver perfusion with endovascular occlusion catheter: preliminary experience in pigs.

Very high concentrations of cytotoxic drug may be obtained with chemotherap y performed with vascular exclusion. Objective : To study the pharmacokinetics and toxicity of melphalan during in situ isolated liver perfusion, and to test an endovascular occlusion cat heter. Methods : Isolated liver perfusion with melphalan (15 mg bolus) was perform ed in 6 pigs (50-60 kg) for 30 min, with non-oxygenated Ringer's solution. Hepatic outflow, collected by a double balloon catheter inserted into the r etrohepatic inferior vena cava, was pumped into the gastroduodenal artery, while the common hepatic artery and portal vein were clamped. Results : A maximum concentration of 30,000 ng/mL was obtained in the circu it before an exponential decrease, while the concentration in systemic bloo d was less than 500 ng/ mt (n = 3). Before closing the abdomen, melphalan c oncentrations were about 2,000 ng/mg in the liver, and undetectable in the muscle. Postoperative course (2 weeks, n = 2) was uneventful with minor alt erations in blood tests and hepatic histology. Conclusion : This method of local chemotherapy with melphalan appears to be safe with minor leakage and minimal toxicity. (C) 2000 Editions scientifiq ues et medicales Elsevier SAS.