Regional intra-arterial chemotherapy for treatment of advanced malignant tumors in children

Abstract

Objective To evaluate the efficacy and long-term outcomes of regional intra-arterial chemotherapy for the treatment of advanced malignant solid tumors in children.Methods During Jul 1999 and Dec 2006,regional intra-arterial chemotherapy was performed in 15 patients (aging from 0.5 to 12 years,6 males and 9 females) with advanced malignant solid tumors in various parts of their bodies.In all the eases,13 accepted preoperative treatment and 2 accepted postoperative treatment.The tumors included rhabdomyosarcoma (2 cases in pelvis,2 in vagina and 1 in bladder),endodermal sinus tumor (3 in sacroiliac and 1 in colic omentum),malignant teratoma (1 in ovary and 1 in cerebellum),desmoplastic small round cell tumor (1 in abdomen),pancreablastoma (1 in root of mesentery),ependymoma (1 in cerebellum) and dermatofibrosareoma (1 in upper arm).Transcatheter arterial infusion chemotherapy (TAIC) of cisplatin,pirarubicin and vindesine was performed with the doses as follows:cisplatin 80 mg/m2,pirarubicin 40 mg/m2 and vindesine 3 mg/m2.Internal lilac artery was chosen as the route of administration for tumors in pelvis,bladder and vagina,internal I|iac artery and coccygeal artery for tumors in sacroiliac,superior mesenteric artery for tumors in abdomen,branch of brachial artery for tumors in upper arm and vertebral artery for tumors in cerebellum.TAIC was repeated every 4 weeks.In the intermission of TALC,intravenous systemic chemotherapy with vindesine,VP16,and ephosphamide were administered.Results In the period of chemotherapy,no cardiotoxicity,nephrotoxicity or hepatic dysfunction were observed except for grade Ⅰ-Ⅱ bone marrow suppression.One patient with ependymoma in the cerebellum got mild hemiplegia and recovered 4 weeks later.The tumors of the 13 patients accepting preoperative treatment were significantly shrunken,localized and could be completely resected.Remnant tumors of the 2 patients who underwent postoperative TAIC disappeared with no recurrence.Thirteen patients survived during the following-up for 4.2 years (2-9 years).One patient lost follow-up.One patient died of tumor recurrence.Conclusions Regional intra-arterial chemotherapy for the treatment of advanced malignant solid tumors in children is feasible and effective.It can be used as preoperative treatment to reduce the tumor size,induce necrosis of the tumor and improve the radical tumor resection rates or can be used to eliminate the postoperative residual tumor to avoid recurrence and metastasis. Key words: Neoplasms; Chemotherapy,cancer,regional perfusion