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How can hepatic artery injection therapy improve the treatment of unresectable liver metastases?
Hepatic arterial injection (HAI) is a medical procedure that delivers chemotherapy drugs directly into the liver. This therapy is not only used to treat liver metastases in patients with colorectal cancer (CRC), but is also often combined with systemic chemotherapy. Although surgical resection remains the standard of care for this type of liver metastasis, the lesions are unresectable in most patients. Therefore, finding effective alternative treatments has become an urgent need in the current medical community.
The blood supply of the liver comes from two main sources: the hepatic artery circulation and the portal vein circulation. Liver metastases mainly rely on the hepatic artery blood supply.
The basic principle of HAI is that liver metastatic cancer cells mainly obtain blood through the hepatic artery, which makes it possible to effectively deliver chemotherapy drugs to cancer cells by directly delivering them through the hepatic artery, thereby improving the treatment effect of liver metastatic cancer.
HAI Programs
Before an HAI pump is installed, the patient will need to undergo an angiogram to delineate the blood supply to the liver and identify any anatomical abnormalities. Next, the physician performs an exploratory laparotomy to confirm the unresectable nature of the tumor and to remove the gallbladder to prevent treatment-induced cholecystitis.
Complete blood removal surgery can minimize the risk of extrahepatic blood transport and ensure the effectiveness of HAI.
During the operation, the doctor will ligate the distal gastroduodenal artery, right gastric artery and other small branches, install a catheter in the correct position of the hepatic artery, and finally place the pump in a subcutaneous bag. Ensure that treatment does not affect other tissues outside the liver by ensuring proper placement and liver perfusion.
Complications of HAI
Possible complications of HAI therapy can be mainly divided into surgery-related, catheter technical complications and chemotherapy drug-related complications. During the procedure, early complications may include hepatic artery thrombosis due to arterial injury and hematoma formation around the pump mouth. Late complications include inflammation or ulceration of the stomach or duodenum and infection of the pump bag.
The key to HAI treatment is monitoring liver function to prevent potential hepatotoxicity.
The most common catheter-related complications are catheter displacement, hepatic artery occlusion, and catheter thrombosis. The incidence of these complications is expected to decrease with increasing experience and improved pump design.
Choice of chemotherapy drugs
The most commonly used drug in HAI therapy is FUDR (fluorouracil), but this drug also has the most significant hepatobiliary toxicity. When patients are undergoing HAI therapy, their liver function needs to be checked regularly to ensure the safety of the treatment. Some studies have found that combining with other chemotherapy drugs (such as adding resveratrol) can not only reduce the biliary toxicity of FUDR, but also improve the response rate.
Future Outlook
With the promotion of new technologies and the accumulation of medical experience, the potential of HAI therapy in the treatment of liver metastases has once again attracted attention. Current studies have shown that after the monopoly of HAI treatment, more effective therapeutic effects can be achieved when HAI is further combined with systemic chemotherapy. Nonetheless, current recommendations are to restrict this therapy to centers with the expertise to ensure patient safety and efficacy.
Will current efforts and innovations bring long-term hope to patients with unresectable liver metastases?
