HPB
Sean J. Judge, MD, MS
Resident in Surgery
University of California, Davis
Sacramento, California, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Recently, an increasing number of new HAI programs has been established around the world. Practice patterns for this complex therapy across these programs have not been reported. This study aimed to identify current practice patterns in HAI therapy by querying members of the international HAI Consortium Research Network (HCRN) with the long-term goal of defining best practices and performing prospective studies.
Methods: Using an online survey tool, a 28-question survey assessing current practices in HAI was developed by 12 HCRN surgical oncologists. Content analysis was used to code textual responses, and the frequency of categories was calculated. For rank-order questions, scores were generated by calculating average ranking for each answer choice.
Results: Twenty-eight HCRN surgical oncologists and eight medical oncologists responded to the survey (78% response rate). The most common intended initial indications for starting an HAI therapy program were unresectable colorectal liver metastases (uCLRM; 100% of respondents) and unresectable intrahepatic cholangiocarcinoma (uIHC; 56% of respondents). Over time, practice patterns evolved such that uCRLM (94% of respondents) and adjuvant therapy for adjCLRM (72% of respondents) were found to be the most common current indications for HAI. Referral patterns for pump placement differed between uCRLM and uIHC, with most patients referred while on second- and first-line therapy, respectively. Based on the survey, physicians preferred to initiate HAI while on first-line therapy. Concern for extrahepatic disease was ranked as the most important factor when evaluating for HAI. All of the institutions utilized HAI floxuridine with dosing most commonly by medical oncologists at 2-week intervals.
Conclusions: Current practice patterns for HAI therapy are relatively uniform across most HCRN centers. Early referral for HAI evaluation is preferred by most providers. Indications for HAI liberated to include adjCRLM as programs developed. The increasing use of HAI as an adjuvant therapy and overall consistency of practice patterns amongst HCRN centers provides a robust environment for prospective data collection and randomized clinical trials.