Hepatic Artery Infusion Therapy for Primary Liver Tumors

Hepatic artery infusion (HAI) therapy for primary liver cancers appears to prolong survival in select candidates with advanced, locoregional disease. A typical candidate is a patient with advanced disease confined to the liver in whom resection, transplantation, and/or ablative therapies are contraindicated due to the extent of disease, recurrence risk, or involvement of hepatic vasculature. For hepatocellular carcinoma, the best evidence supporting HAI therapy involves the utilization of intra-arterial 5-FU with or without cisplatin, often in conjunction with intramuscular or subcutaneous IFN-a. Patients with concomitant cirrhosis tend to have worse outcomes, while those with hepatitis C have a better prognosis if treated with ribavirin. For cholangiocarcinoma, HAI therapy appears to confer a survival advantage, but evidence is limited to case series, and the wide variety of regimens employed precludes any definitive conclusions regarding optimal therapy. Toxicities depend on the chemotherapeutic agents used but most commonly involve cytopenias or elevation in liver function tests, which almost never require intervention. Though rare, serious complications such as hepatic decompensation or cholangitis can be fatal. Technical complications related to the device are uncommon and can usually be resolved with replacement. Routine cross-sectional imaging should be performed to assess response to therapy. Patients with exceptional responses may become eligible for other therapies such as resection or ablation, while nonresponders should be triaged to alternative chemotherapeutic agents or other treatment modalities.