Melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation for primary or metastatic cancer in the liver

Evidence on the safety of melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation for cancer or metastases in the liver shows there are serious, well‑recognised complications.

• For patients with metastases in the liver from ocular melanoma, there is some evidence of short‑term tumour response. For these patients, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

• For patients with primary liver cancer or metastases in the liver that are not from ocular melanoma, evidence of efficacy is inadequate in quality and quantity. For these patients, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

Clinicians wishing to do melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation for patients with metastases in the liver from ocular melanoma should:

• Inform the clinical governance leads in their healthcare organisation.

• Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.

• Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

• Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).

• Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

Healthcare organisations should:

• Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.

• Regularly review data on outcomes and safety for this procedure.

The procedure should only be done in specialist centres by a melanoma multidisciplinary team that includes an interventional radiologist, an anaesthetist, an oncologist and a clinical perfusion scientist trained and experienced in the procedure.

Further research should be in the form of randomised controlled trials against current best practice, including other liver‑directed and systemic therapies. It should report details of patient selection, concurrent therapies and techniques, and adverse events, including those related to chemotherapy.