There have been a lot of technical innovations in the last 10 years that have made treatment for these metastases more efficient. Along with systemic chemotherapy, these approaches have targeted therapy for liver metastasis, the so-called “liver-directed therapy.” These options include:

• Microwave ablation: This alternative to surgery uses a probe to direct microwave heat into the liver to kill cancer cells. It is only used in tumors up to 4 cm in size.
• Y-90 radioembolization: Also known as selective internal radiation therapy (SIRT) or Y-90 microsphere therapy, it is placed percutaneously by interventional radiologists and provides selective radiation to liver tumors.
• Stereotactic-body radiation (SBRT): It delivers conventional radiation by an external machine.
• Hepatic artery infusion (HAI) chemotherapy: This approach aims to deliver chemotherapy directly to the liver. It has shown increased rates of conversion to resection of liver tumors compared to the other options. Therefore, it holds promising outcomes, especially for widespread liver metastasis.

HAI is a type of regional chemotherapy to treat advanced colorectal cancer that has spread to the liver. It delivers a high dose of chemotherapy directly into the liver's blood supply using a pump that surgeons implant under your skin.

HAI, which is approved by the US Food and Drug Administration (FDA), is beneficial in:

• Colorectal cancer that has spread to the liver
• Bile duct cancer (cholangiocarcinoma)

This treatment may not be an option for you if your cancer has spread to several sites beyond the liver or if you are not healthy enough for surgery.

The hepatic artery provides the primary vascular supply to the tumor, with more than 80 percent of the blood flow to the tumor being derived from the hepatic artery, whereas the normal liver parenchyma receives most of its blood flow via the portal vein.

Because HAI is delivered directly into the liver, higher disease of chemotherapy medications, nearly 400 times higher than conventional IV chemotherapy, is used to destroy the liver tumors. Also, these medications remain in the liver, as opposed to conventional therapy, thereby reducing side effects such as nausea and vomiting, among many others. This has been shown to improve patients' quality of life. HAI is shown to reduce risk of tumors coming back after resection and helping patients live longer. For those patients who are not candidates for surgery, HAI can shrink tumors, enabling them to have surgery in the future.

The pump is placed surgically, possibly at the same time as other surgical procedures such as colon removal, gallbladder removal, and resection of liver tumors. Sometimes, the pump is placed alone in cases where tumors are unresectable.

The pump is placed in the abdominal wall. This pump is connected to a catheter inserted in a blood vessel connected to your hepatic artery.

The surgery for the pump usually takes between two to three hours. However, it may sometimes take longer if other procedures are required during the surgery. The hospital stay is usually three to six days after surgery.

The therapy is planned to last four to six months initially. While on therapy, you will need to visit the cancer center every two weeks to have your pump refilled, along with lab draws and conventional chemotherapy. Refilling the pump takes about 10 minutes.

After the surgery, it usually takes four weeks to recover to place your hepatic artery pump. After you recover from your surgery, you can return to most of your usual activities. But, there are some activities you should avoid:

• Avoid rough physical activities (such as contact sports). They can cause an injury to your pump site.
• Avoid lifting objects heavier than 10 pounds (4.5 kilograms). This can make your pump move out of place.
• Avoid strenuous exercise (such as running or jogging). It can make the catheter move out of place.
• Check with your healthcare provider before you travel by airplane. Pressure changes in the cabin can cause your medication to flow faster.
• Avoid deep sea or scuba diving. You can swim or snorkel.
• Avoid activities that can raise your body temperature. They can make your medication flow faster. Do not:
  • Place heating pads, electric blankets, or hot water bottles directly on your pump site.
  • Go in a sauna or hot tub.

The pump usually stays for at least six months but can stay longer if more treatments are needed. After treatment is completed, you only have to come every six weeks to refill the pump with a drug-free liquid to keep the pump working appropriately. If removal is indicated, the pump is removed under local anesthesia. The catheter, however, remains permanently in the blood vessel connected to your hepatic artery.

Currently, HCA Florida North Florida Hospital in Gainesville, in partnership with Florida Cancer Specialists, is the only institution in North Central Florida to offer this innovative therapy to patients.

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