Percutaneous hepatic perfusion in unresectable liver metastases: focus on ocular melanoma

Meijer, T.S. (2023)

Doctoral Thesis

Ocular melanoma and colorectal carcinoma are two malignancies with a predilection for metastasizing to the liver. Patients with liver-only or liver-dominant metastatic disease might be eligible for locoregional or so-called liver-directed therapy. Liver-directed therapies include surgery and thermal ablation, as well as various arterial therapies such as percutaneous hepatic perfusion with melphalan (M-PHP). Although M-PHP is well-tolerated by most patients, hematologic events due to bone marrow suppression were quite common in M-PHP using the first-generation filter. In an attempt to reduce bone marrow suppression by increasing the filter extraction rate, a new second-generation filter (GEN 2 filter) was developed and became commercially available in 2012. In this thesis, it was demonstrated that M-PHP using the GEN 2 filter has an acceptable safety and toxicity profile and it seems to reduce hematologic toxicity when compared to M-PHP with a first-generation filter. This thesis contributes to the scientific evidence showing that M-PHP using the GEN 2 filter is an effective treatment for liver metastases from ocular melanoma. In contrast, M-PHP seems to have no additional value in the current treatment of unresectable liver metastases from colorectal carcinoma.

• Percutaneous hepatic perfusion
• Melphalan
• PHP
• Liver metastases
• Ocular melanoma
• Uveal melanoma
• Liver-directed therapy
• Colorectal liver metastases
• GEN filter

• All authors: Meijer, T.S.
• Supervisor: Geus-Oei, L.F. de
• Co-supervisor: Burgmans, M.C.; Kapiteijn, H.W.
• Committee: Hage, J.A. van der; Rijswijk, C.S.P. van; Meijerink, M.R.; Delden, O.M. van; Vahrmeijer, A.L.; Luyten, G.P.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2023-03-29
• ISBN (print): 9789464197211