What Is Hepatic Arterial Infusion Therapy?
Hepatic arterial infusion refers to a medical procedure involving the administration of therapeutic agents directly into the hepatic artery, which is the main blood vessel supplying the liver.
Hepatic Arterial Infusion (HAI) is a form of chemotherapy that is administered through a pump system attached to the liver. This enables medical professionals to utilize the distinctive anatomical features of the liver.
The majority of the liver's blood supply is derived through the portal vein. However, it is common for liver tumors to receive blood supply from an alternative source, namely the hepatic artery. The utilization of the hepatic artery enables medical practitioners to internally target liver tumors with reduced adverse effects compared to conventional chemotherapy.
Who Can Receive an Infusion of Hepatic Artery?
HAI can assist patients in:
- The spread of malignancy to the liver, also known as colorectal liver metastasis or CRLM. Approximately fifty percent of colorectal cancer patients develop CRLM. This is the most frequent reason for a HAI.
- Initial liver carcinoma.
- Hepatocellular malignancy.
- Cancer of the bile duct that originates in the liver (also known as intrahepatic cholangiocarcinoma).
- Other cancers that have metastasized to the liver.
Physicians may use HAI:
- After surgery, any liver cancer cells could be eliminated.
- Before surgery, to shrink tumors to make removal easier.
- In surgery, the tumors are typically too deeply rooted in the liver to be removed. Occasionally, HAI reduces tumors sufficiently to make them removable. When this is not feasible, HAI can shrink tumors sufficiently to alleviate the effects of cancer.
What Are the Advantages of the Procedure?
Hepatic arterial infusion (HAI) has the potential to extend patients' lifespans and enhance their overall well-being. As an illustration, certain individuals may present with tumors that are not willing to undergo surgical intervention. The utilization of HAI also presents other advantages:
- Hepatic arterial infusion (HAI) enables physicians to administer a significantly elevated dosage of drug directly to the liver, surpassing typical chemotherapy levels.
- The liver is responsible for metabolizing around 95 percent of administered medications, resulting in a significant reduction in the occurrence of adverse effects.
- The medicine is administered continuously throughout a 24-hour period, seven days a week, for a duration of two weeks.
What Are the Limitations Associated With This Procedure?
Similar to other surgical procedures, HAIR treatment possesses several limitations and risks:
- Certain patients may not meet the necessary medical criteria to undergo surgical intervention for the implantation of the pump.
- Certain individuals may present with cancer that has developed beyond the confines of the liver.
- Every surgical procedure has the potential for problems. Hospitals with a higher frequency of performing the surgery exhibit a diminished level of risk.
- Patients with Hair Autoimmune Alopecia (HAI) experience positive outcomes through the provision of continuous medical assistance subsequent to the treatment.
What Technological Factors Are Involved?
- To assess hepatic artery vascularization and portal vein patency, angiography of the celiac trunk and superior mesenteric artery was conducted through the femoral artery.
- Any anti-cancer drug reflux into the gastrointestinal system and out of the liver is a contraindication to HAIC.
- The non-tumor feeding arteries are embolized to prevent cytotoxic drug reflux into both uninvolved liver parenchymas and extrahepatic organs like the stomach and duodenum.
- Following the identification of the tumor-feeding artery, the catheter was placed into the appropriate hepatic or common hepatic artery and attached to the port system.
- The port device will be placed in a subcutaneous pocket and implanted in the right or left iliac fossa; for the implantation of the infusion port in the hepatic artery, an infusion pump is required to avoid the reflux of chemotherapy drugs.
What Are the Problems and Safety Precautions That Are Now in Existence?
The adverse effects associated with the utilization of hepatic arterial infusion chemotherapy (HAIC) were documented as including fever, jaundice, gastrointestinal issues (such as nausea, vomiting, or abdominal discomfort), as well as complications at the site of port insertion, such as infection and thrombosis.
The incidence of post-embolization problems in hepatic arterial infusion chemotherapy (HAIC) is comparatively reduced as compared to transarterial chemoembolization (TACE). Specifically, transarterial chemoembolization (TACE) has the potential to cause the following unfavorable outcomes: damage to the hepatic artery resulting in stenosis or blockage, as well as the formation of collateral vessels such as periportal or inferior phrenic artery. The occurrence of HAIC may be prevented by the presence of certain problems. There have been instances where hepatic or renal failure has been documented. The occurrence of these cases could perhaps be attributed to preexisting liver illness or disease advancement rather than being solely a result of the toxic effects of hepatic arterial infusion chemotherapy (HAIC).
What Are the Applications of Hepatic Arterial Infusion in the Treatment of Advanced Cancers?
- Hepatic arterial infusion (HAI) is a therapeutic modality employed for the management of specific cases of advanced hepatic malignancies.
- The direct delivery of chemotherapy to the liver allows for the administration of far larger doses of the medication, hence enhancing its efficacy compared to systemic chemotherapy while minimizing potential harm to other bodily tissues.
- HAIP chemotherapy has demonstrated efficacy in the treatment of advanced tumors such as metastatic colorectal cancer and cholangiocarcinoma, specifically cancers affecting the bile ducts.
What Is the Hepatic Arterial Infusion Treatment Modality for Metastatic Colorectal Cancer?
- The current standard of care for metastatic colorectal cancer is the use of chemotherapy in combination with targeted therapies.
- Approximately 60 percent of patients diagnosed with colorectal cancer will experience the development of liver metastases during the progression of their illness.
- The utilization of hepatic arterial infusion pump (HAIP) chemotherapy in the management of metastatic colorectal cancer (CRC) that has invaded the liver has demonstrated the potential for improved therapeutic outcomes compared to the administration of systemic chemotherapy as a standalone treatment.
- The implantation of the chemo pump for colorectal cancer may be performed together with tumor excision or as a separate procedure.
Hepatic Arterial Infusion Treatment Modality for Cholangiocarcinoma
The current standard of care for cholangiocarcinoma is hepatic arterial infusion (HAI) chemotherapy, which includes:
- Cholangiocarcinoma, often known as bile duct cancer, ranks as the second most prevalent primary malignancy affecting the liver.
- The administration of systemic chemotherapy as a standalone treatment approach yields suboptimal response rates, and the overall prognosis for patients diagnosed with cholangiocarcinoma remains unfavorable.
- The integration of systemic chemotherapy with hepatic arterial infusion pump (HAIP) chemotherapy has been observed to yield enhanced treatment responses and increased survival rates among patients diagnosed with cholangiocarcinoma.
- It possesses the capability to reduce the size of a tumor that cannot be surgically removed on its own, enabling a subsequent surgical procedure for complete resection of the tumor.
Conclusion
The field of HAI chemotherapy has made significant advancements because of enhancements in surgical technique, the accumulation of institutional expertise in pump insertion and monitoring, and the identification of novel therapeutic chemicals. The future outlook for hepatic arterial infusion (HAI) chemotherapy appears promising, and is currently investigating the efficacy of combining different chemotherapeutic agents. The outcomes of converting patients who were first deemed unresectable to resection may potentially lead to the application of this approach as neoadjuvant therapy. The development of molecular markers remains a topic of interest in determining whether patients are likely to benefit from hepatic arterial infusion (HAI), particularly in light of the emergence of novel targeted systemic medicines. The complex molecular processes involved in colorectal cancer (CRC) development deepen, and there is a growing interest in developing a more precise and focused approach to the treatment of CRC. Further investigation is necessary to conduct additional clinical trials on HAI therapy, with a focus on differentiating the response based on the genotypic mutational status of colorectal cancer (CRC) patients.
