Initial outcomes of a single-institution hepatic artery infusion pump program for colorectal liver metastases and intrahepatic cholangiocarcinoma: Safety, feasibility, and circulating tumor DNA tracking

IF 2.7 2区医学 Q1 SURGERY Surgery Pub Date : 2025-06-01 Epub Date: 2025-03-14 DOI:10.1016/j.surg.2025.109325

Lee M. Ocuin MD, FACS, FSSO , Henry Stitzel MD , Michelle Chung MD , Sree Harsha Tirumani MD , Mohamedraed Elshami MD, MMSc , Maria Tomaro MSN, CNP, OCN , Jennifer L. Miller-Ocuin MD , David W. Deitz MD, MHCDS , Emily Steinhagen MD , Ronald Charles MD , Meagan Costedio MD , Michael Liu MD , Melissa Lumish MD , J. Eva Selfridge MD, PhD

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Abstract

Background

Hepatic artery infusion with floxuridine is a treatment option for patients with colorectal liver metastases or intrahepatic cholangiocarcinoma. Outcomes from newer centers are understudied. Predictive markers are needed, and quantitative circulating tumor DNA is an emerging candidate method for predicting response in patients receiving hepatic artery infusion. We aimed to describe safety, feasibility, early oncologic outcomes, and quantitative circulating tumor DNA dynamics in patients treated with hepatic artery infusion at a newly established program.

Methods

Single-institution analysis of patients who underwent hepatic artery infusion pump placement (April 2022–April 2024) was conducted. Primary outcomes included safety and feasibility (receiving ≥1 cycle of floxuridine). Secondary outcomes included radiographic response (Response Evaluation Criteria in Solid Tumors 1.1), relative dose intensity of floxuridine received, and quantitative circulating tumor DNA response.

Results

A total of 36 patients underwent hepatic artery infusion pump placement (colorectal liver metastases: 32; cholangiocarcinoma: 4). Technical success was 100%. Feasibility was 97%. One patient experienced mortality at 90 days from disease progression. Three patients (8%) experienced a total of 5 hepatic artery infusion pump-specific complications (pump pocket [n = 3], hemorrhage [n = 1], biliary sclerosis [n = 1]). Median relative dose intensity was 68.5% (colorectal liver metastases: 68.3%; cholangiocarcinoma 72.5.0%). For the 27 patients who underwent floxuridine therapy with available postoperative imaging, disease control rate was 97% (partial response: n = 15; stable disease: n = 11). Quantitative circulating tumor DNA was obtained from 16 patients (44%). Circulating tumor DNA dynamics appeared to correlate with and precede radiographic response.

Conclusions

Implementation of a new hepatic artery infusion program is safe and feasible with promising early oncologic outcomes. Circulating tumor DNA tracking is achievable and dynamic changes in circulating tumor DNA may correlate with radiographic response to treatment.

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单机构肝动脉输注泵治疗结直肠癌肝转移和肝内胆管癌的初步结果：安全性、可行性和循环肿瘤DNA跟踪

背景：肝动脉输注氟尿定是结直肠肝转移或肝内胆管癌患者的一种治疗选择。新中心的结果尚未得到充分研究。预测标志物是必要的，定量循环肿瘤DNA是预测肝动脉输注患者反应的一种新兴的候选方法。我们旨在描述在一个新建立的项目中接受肝动脉输注治疗的患者的安全性、可行性、早期肿瘤预后和定量循环肿瘤DNA动力学。方法对2022年4月~ 2024年4月行肝动脉灌注泵置入的患者进行单机构分析。主要结局包括安全性和可行性（接受氟尿定≥1个周期）。次要结果包括放射学反应（实体瘤反应评价标准1.1）、氟尿定的相对剂量强度和定量循环肿瘤DNA反应。结果36例患者行肝动脉灌注泵置入术(结肝转移32例；胆管癌4例，技术成功率100%。可行性为97%。一名患者在疾病进展90天后死亡。3例（8%）患者共出现5例肝动脉灌注泵特异性并发症（泵袋[n = 3]、出血[n = 1]、胆道硬化[n = 1]）。中位相对剂量强度为68.5%(结肝转移：68.3%；胆管癌72.5.0%)。27例接受氟尿定治疗并有术后影像学检查的患者，疾病控制率为97%(部分缓解：n = 15；病情稳定：n = 11)。从16例（44%）患者中获得定量循环肿瘤DNA。循环肿瘤DNA动力学似乎与放射学反应相关并先于放射学反应。结论实施一种新的肝动脉输注方案是安全可行的，具有良好的早期肿瘤预后。循环肿瘤DNA跟踪是可以实现的，循环肿瘤DNA的动态变化可能与放射学对治疗的反应有关。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.