<unk>  <unk>  is a medical procedure that delivers chemotherapy directly to the liver. The procedure, mostly used in combination with systemic chemotherapy, plays a role in the treatment of liver metastases in patients with colorectal cancer (CRC). Although surgical resection remains the standard of care for these liver metastases, majority of patients have lesions that are unresectable. The liver derives its blood supply from two sources – via the hepatic<unk>  circulation and the portal circulation. Liver metastases get most of their blood supply primarily from the hepatic artery, whereas the normal liver cells get their blood supply from the portal circulation. This allows for chemotherapeutic drugs to be delivered directly to the cancer cells if infused into the hepatic artery. Multiple trials have compared<unk>  (with various chemotherapeutic agents) to systemic chemotherapy. Compared to systemic Fluoropyrimidine,<unk>  with Floxuridine (FUDR) had an increased response, but there was no overall increase in patient survival. Efforts have been made to increase the efficacy and safety of<unk>  chemotherapy: when a combination of FUDR and dexamethasone was used for<unk> , both response rate and median survival increased. In another study, a combination of FUDR and leucovorin for<unk>  increased the response rate, and reduced the biliary toxicity seen with the use of FUDR alone. Considering improvements in the surgical placement of the<unk>  pump and studies showing promising results when<unk>  therapy is used together with systemic oxaliplatin or irinotecan, there is once again an increased interest in the role of<unk>  as a treatment option in patients with cancer, who have unresectable CRC liver metastases. However, studies recommend that this treatment modality be restricted to centers with expertise in the surgical placement of these pumps, and the technical aspects of localized chemotherapy.
Hepatic arterial infusion
Percutaneous hepatic perfusion
Isolated hepatic perfusion
Peritoneovenous shunt
Continuous hyperthermic peritoneal perfusion
Perihepatic packing
Hepatic artery embolization
Intraosseous infusion