Hepatic arterial infusion (HAI)
Hepatic arterial infusion (HAI) is a specialized procedure that delivers chemotherapy directly to the liver through a catheter implanted into the artery supplying the organ. This method is primarily utilized for treating liver tumors, particularly those resulting from colon or rectal cancers that have metastasized to the liver and are not amenable to surgical removal. One of the key advantages of HAI is its ability to achieve drug concentrations in the liver that are up to 400 times higher than those achieved with systemic chemotherapy, significantly reducing the systemic side effects typically associated with chemotherapy treatment.
Before undergoing HAI, patients are carefully evaluated for suitability through a thorough review of their medical history and imaging studies, such as computed tomography (CT) scans and hepatic arteriography. The procedure involves surgically placing a titanium pump and catheter, which allows for the continuous infusion of chemotherapy agents like floxuridine, cisplatin, or doxorubicin. While HAI may result in fewer systemic side effects, patients might experience localized effects, such as abdominal pain or diarrhea.
Overall, HAI has been shown to provide a higher response rate in patients with inoperable liver tumors compared to traditional systemic chemotherapy, making it a valuable option in the management of specific cancer cases.
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Hepatic arterial infusion (HAI)
ALSO KNOWN AS: Regional chemotherapy, intra-arterial chemotherapy
DEFINITION: Hepatic arterial infusion (HAI) is the delivery of chemotherapy treatment directly to the liver by a catheter (thin tube) surgically implanted to the artery leading to the organ; the other end of the catheter is attached to a pump with a chemotherapy drug.
Cancers treated: Tumors of the liver, including colon or rectal cancer that has spread to the liver
Why performed: Liver tumors that cannot be operated on because of their size or location may be treated with HAI. An advantage of this procedure is the high concentrations of the drug sent directly to the liver. It can provide 400 times higher drug concentration compared with systemic chemotherapy. Since the drug is broken down in the liver, the rest of the body does not suffer the side effects of the chemotherapy.
Patient preparation: The selection of patients who would benefit from HAI is important, and evaluation includes a review of the disease history and a computed tomography (CT) scan looking for metastasized disease in the chest, abdomen, and pelvis. Patients also undergo a test called hepatic arteriography to look specifically at the health of the arteries leading to the liver.
Steps of the procedure: An incision is made under the right rib cage to place the catheter in the gastroduodenal artery, which joins the arteries to the liver. An incision is also made on the left side of the abdomen where the pump will be implanted. The pump is made of a circle of titanium about 3 inches wide. The pump storage reservoir is filled with sterile water and a blood thinner (heparin), and the pump is turned on. The pump is subsequently filled with the chemotherapy drug, and cycles of two weeks of chemotherapy followed by two weeks of water and heparin are started. The chemotherapy agents delivered by HAI include floxuridine, cisplatin, or doxorubicin.
During the procedure, the surgeon also performs a cholecystectomy (removal of the gallbladder) to prevent chemotherapy from going to the gallbladder.
After the procedure: The pump is refilled as needed with a needle through the skin to the pump reservoir. The pump does not interfere with normal activities.
Risks: There may be technical complications, including infection at the site of pump placement. Most of the systemic side effects of chemotherapy (such as nausea and vomiting) are bypassed with this treatment, but there may be side effects such as abdominal pain and diarrhea.
Results: The use of HAI in inoperable liver tumors shows a higher response rate than does traditional systemic chemotherapy.
Bibliography
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Clavien, Pierre-Alain. Malignant Liver Tumors: Current and Emerging Therapies. Chichester: Wiley, 2010. Print.
Fong, Yuman, and Jia-Hong Dong. Hepatobiliary Cancer. Shelton: People's Medical, 2013. Print.
“Hepatic Artery Infusion (HAI) Therapy Is Now Available Nationwide in More than 65 Medical Centers.” PRWeb, 30 Jan. 2024, www.prweb.com/releases/hepatic-artery-infusion-hai-therapy-is-now-available-nationwide-in-more-than-65-medical-centers-302047864.html. Accessed 20 June 2024.
Ko, Y J, and P J Karanicolas. “Hepatic Arterial Infusion Pump Chemotherapy for Colorectal Liver Metastases: An Old Technology in a New Era.” Current Oncology (Toronto, Ont.) 21.1 (2014): e116-21. doi:10.3747/co.21.1592. Accessed 20 June 2024.
Perry, Michael C., Donald C. Doll, and Carl E. Freter. Chemotherapy Source Book. 5th ed. Philadelphia: Lippincott, 2012. Print.