Neoadjuvant intra-arterial chemotherapy using an original four-lumen double-balloon catheter for locally advanced uterine cervical cancer

Tomohito Tanaka,Satoe Fujiwara,Masahide Ohmichi,Yoshimichi Tanaka,Satoshi Tsunetoh,Hiroshi Sasaki,Takashi Yamada,Yoshito Terai,Kazuhide Yamamoto

doi:10.18632/oncotarget.26518

Tomohito Tanaka, Satoe Fujiwara + Show 7 more

Open Access

https://doi.org/10.18632/oncotarget.26518

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Journal: Oncotarget	Publication Date: Dec 28, 2018
Citations: 4	License type: cc-by

Affiliation: Osaka Medical and Pharmaceutical University

Abstract

OBJECTIVEWe report a balloon-occluded arterial infusion therapy with an original four-lumen double-balloon catheter (4L-DB) which allows for the efficient injection of an anticancer agent at a high concentration to the target spot for patients with locally advanced uterine cervical cancer.METHODSOne hundred and forty-three patients with locally advanced cervical cancer treated with neoadjuvant intra-arterial chemotherapy (NAIAC) or a primary radical hysterectomy (PRH) were retrospectively assessed. The patients in the NAIAC group received irinotecan 70 mg/m2 intravenously on day 1 and 8 and cisplatin 70 mg/m2 intra-arterially using the 4L-DB on day 2 of a 21-day course, and two courses were performed in principle. The radical hysterectomy was performed within 6 weeks after NAIAC.RESULTSNinety-four patients were treated with NAIAC, and 49 patients undertook a PRH. The response rate of NAIAC on MRI was 92.6%. Fourteen patients (14.6%) had no evidence of cancer cells on pathologic diagnoses. The NAIAC group had a longer disease-free survival than the PRH group (p=0.02); however, the overall survival was not significantly different. The relative risk (RR) for recurrence was higher in patients with lymph node metastasis (RR, 4.31; 95% CI, 2.23-8.43) and lower in those who underwent NAIAC (RR, 0.30; 95% CI, 0.14-0.68).CONCLUSIONOur results with NAIAC using the 4L-DB catheter in locally advanced cervical cancer indicates beneficial effects on primary lesions and improves disease-free survival.

Highlights

We previously reported a neoadjuvant intra-arterial chemotherapy (NAIAC) using an original four-lumen double-balloon (4L-DB) catheter (Figure 1) [1]
Ninety-four patients were treated with NAIAC, and 49 patients undertook a primary radical hysterectomy (PRH)
The relative risk (RR) for recurrence was higher in patients with lymph node metastasis (RR, 4.31; 95% CI, 2.23-8.43) and lower in those who underwent NAIAC (RR, 0.30; 95% CI, 0.14-0.68)

Summary

Introduction

We previously reported a neoadjuvant intra-arterial chemotherapy (NAIAC) using an original four-lumen double-balloon (4L-DB) catheter (Figure 1) [1]. This catheter can expand the balloon in the internal iliac artery on the central and peripheral side of the uterine artery and selectively inject the anticancer agent into the uterine artery; the anticancer drug will not flow into other arteries, such as the inferior vesical artery, middle rectal artery, inferior gluteal artery or obturator artery. In accord with the National Comprehensive Cancer Network’s (NCCN) clinical guidelines, surgery or concurrent chemoradiotherapy (CCRT) is recommended in patients with stage IB1 and, in IIA1 cases, neoadjuvant chemotherapy (NAC) is not recommended [10] because a meta-analysis showed no advantage for NAC [11]. The appropriate treatment of stage IB2, IIA2 and IIB remains uncertain

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Results

Conclusion