Tumor Necrosis Factor in Isolated Hepatic Perfusion: credits, debits and future directions

Patients with irresectable hepatic malignancies remain an intriguing clinical problem. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and approximately one million individuals will develop this tumor per year. The incidence of these tumors varies widely worldwide, being most common in the Far East [1]. Recent advances in the early detection of these tumors have improved the prognosis and long-term survival has been reported in patients with small, encapsulated malignancy [2-4]. Nevertheless, the overall prognosis of HCC remains poor and usually expressed in months rather than years [5, 6] Metastatic disease from colorectal cancer is the most common hepatic malignancy in the Western countries. Most frequently, the liver is the site of dissemination with many other sites in the body (lung, brain, bone). On the other hand, in as many as 30 % of patients the liver is the sole site of initial cancer recurrence [7]. If left untreated the mean survival rate in these patients is approximately 6 to 9 months. In contrast, 5-year survival rates up to 35 % have been reported for patients amendable to resection [8-11]. Unfortunately in the majority (75 %) of the patients that have been diagnosed with colorectal cancer metastases confined only to the liver, these metastases are considered unresectable. These patients are eligible for other therapies.