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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2001 RITA Medical Systems, Inc. | Contact Us | Disclaimer
| Last modified: Friday, October 10, 2003
