HEPATIC ARTERY INFUSION CHEMOTHERAPY (HAI)
What is hepatic artery infusion chemotherapy
HAI chemotherapy is designed to improve chemotherapy benefits for liver cancer by increasing the amount of chemotherapy delivered to the site of the tumor. Chemotherapy is dispensed from an specialized infusion system in which a catheter is placed into the hepatic artery to directly deliver the chemotherapy to the liver. A fully implanted system is used so that the pump that connects to the catheter in the hepatic artery is implanted under the skin. This allows for long-term administration of chemotherapy medication directly into the liver. The pump is periodically filled with chemotherapy by your oncologist.
Direct infusion of chemotherapy into the liver minimizes the side-effects of the chemotherapy and allow high doses to be administered. Infusion of chemotherapy directly into the hepatic artery (HAI) to minimize the side effects of the chemotherapy is an option in selected patients with liver cancer or metastatic spread of cancer to the liver.
This treatment has been of special interest in patients with colorectal cancer with liver metastasis. Because liver metastases from colorectal cancer derive more than 80% of their blood supply from the hepatic artery, hepatic arterial infusion is well suited as an alternative or together with systemic chemotherapy for the treatment of liver tumors. Hepatic artery infusion of chemotherapy has also been used in patients after liver resection (removal) for colorectal cancer spread to the liver.
Benefits of HAI
HAI therapy enhances quality of life
The demonstrated reduction in side effects with regional chemotherapy vs. systemic chemotherapy can increase the patient's quality of life. Even with progressive increase in hepatic tissue replacement, physical symptoms tended to occur late in the course of the disease.The development of fully implanted pumps allows the patient to be mobile and reduces the need for frequent clinic visits for drug infusion. Further, these pumps have an advantage over port access systems because they usually require little or no home care, such as maintenance of the port. Patients often can participate in activities of daily life as their illness permits with little hindrance from side effects or administration of chemotherapy.
How is hepatic artery infusion chemotherapy (HAI) administered
Your doctor will place the pump just under the skin of your abdomen, just above or below your belt line. The pump is placed on the right side of your abdomen under the skin through a 6 inch long abdominal incision.
To insert the catheter into the hepatic artery your surgeon has to open the abdomen. On opening the abdomen a branch of the hepatic artery is identified for insertion of the catheter. More than likely, your doctor will remove your gallbladder when implanting the pump. The gallbladder is connected to the liver by blood vessels. As a result, if the gallbladder is not removed, some of the chemotherapy that is delivered to the liver could travel to the gallbladder and may cause inflammation of the gallbladder.
Once the catheter and pump are in place, your doctor will attach the catheter to the pump. The pump is filled after the surgery with chemotherapy that is then pumped directly into the liver through the catheter in the hepatic artery.
Laparoscopic techniques to insert the hepatic artery infusion device
Insertion of HAI device require opening the abdomen to place the catheter into the hepatic artery. At USC, Dilip Parekh M.D. has developed a laparoscopic procedure for placing the catheter into the hepatic artery. This advance laparoscopic technique avoids the large incision associated with open laparotomy that is usually performed to place the catheter into the hepatic artery. Furthermore the postoperative recovery is much shorter and patients can be treated soon after the placement of the pump.
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