Arterial Chemotherapy Research Articles

Characteristics of hepatocellular carcinoma arising from Fontan-associated liver disease.

Hepatocellular carcinoma (HCC) can arise from Fontan-associated liver disease (FALD); this is known as FALD-HCC. The clinical features of FALD-HCC are unclear. Thus, we examined the incidence and clinical characteristics of FALD-HCC. From 1972 to 2019, 122 patients developed liver disease after undergoing Fontan procedures. HCC was diagnosed in 12 (9.8%) FALD patients. We compared FALD-HCC and non-HCC patients. The incidence of HCC was 0.8% and 2.9% in FALD 10 and 20years after the Fontan procedure, respectively. The median age of patients at diagnosis of HCC was 32.5years (range 20.6-46.1years), and seven of the 12 patients were men. Patients with FALD-HCC had a higher incidence of liver cirrhosis and polysplenia than non-HCC patients. Liver tumors were detected as single nodules in eight patients, and the median diameter was 47mm (range 11-105mm). HCC was treated by surgical resection in two patients, transcatheter arterial chemoembolization or chemotherapy in three patients, and proton beam therapy in four patients. Three patients could not be treated because of their poor condition. Four patients died of liver/cardiac failure and HCC, and HCC was controlled in three patients. The survival rate after 25years was significantly lower in patients with FALD-HCC than non-HCC patients (68.6% vs. 97.9%, respectively; P < 0.01). Of the 122 patients with FALD, 12 developed HCC 20years after surgery. Because complications of HCC are associated with poor prognosis, constant surveillance for HCC should begin 10years after surgery.

MP55-13 ADJUVANT INTRAARTERIAL CHEMOTHERAPY FOLLOWING SURGERY IN TREATING PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER: A CHINA,PROSPECTIVE, MULTICENTER, RANDOMIZED PHASE III TRIAL

You have accessJournal of UrologyBladder Cancer: Invasive II (MP55)1 Apr 2020MP55-13 ADJUVANT INTRAARTERIAL CHEMOTHERAPY FOLLOWING SURGERY IN TREATING PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER: A CHINA,PROSPECTIVE, MULTICENTER, RANDOMIZED PHASE III TRIAL Lijuan Jiang, Kai Yao, Zike Qin, Fangjian Zhou, and Zhuowei Liu* Lijuan JiangLijuan Jiang More articles by this author , Kai YaoKai Yao More articles by this author , Zike QinZike Qin More articles by this author , Fangjian ZhouFangjian Zhou More articles by this author , and Zhuowei Liu*Zhuowei Liu* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000924.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Introduction: Neoadjuvant chemotherapy showed survival benefit in randomized trials and meta-analyses. Adjuvant chemotherapy after radical cystectomy for patients with pT3/4 and/or LN positive (N+) disease without metastases (M0) is still under debate for the limited evidence. This was an open-label, prospective, multicenter, randomized, controlled phase III two-arm study. Patients with locally advanced urothelial carcinoma of the bladder after cystectomy were randomly assigned (1 : 1) to 1 of 2 treatment arms. Arm 1 (control): No immediate post-surgery treatment. Patients undergo observation followed by intra-arterial cisplatin and gemcitabine at local relapse, or receive intravenously chemotherapy with cisplatin and gemcitabine at multiple metastases. Arm 2 (treatment): Surgery of percutaneous catheter system for arterial chemotherapy was done in the Department of Invasive Technology. All medications were administered using percutaneous catheter system via a modified Seldinger technique. Treatment would begin between 1-5 weeks after radical cystectomy (within 40 days is recommended). Objective: The purpose of the study was to evaluate the benefit of adjuvant intraarterial chemotherapy (IAC) versus radical cystectomy alone in patients with locally advanced bladder cancer. METHODS: One hundred and sixty-one patients with bladder cancer of pT3-4 or N1-3 without distant metastasis were randomly allocated to control group (75 patients) or to three courses of GC (86 patients). These latter patients were further to receive gemcitabine 800 mg/m2 intra-arterial, cisplatin 25 mg/m2 intra-arterial once a week for 3 weeks followed by 1-week rest period. Maximum of three cycles. RESULTS: At a median follow-up of 33 months, the 5-year overall survival (OS) was 40%, with a statistical difference between the two groups (P=0.037, IAC group 55.4% and control group 41.7%, respectively). The 2 and 1 arms had significantly different disease-free survival(DFS) (P=0.021, 55.4% and 41.7%, respectively). About 79% (68/86) of patients received the planned cycles, and hematologic toxicity was the most common. CONCLUSIONS: Gemcitabine combined with cisplatin intra-arterial adjuvant chemotherapy proved to be an effective adjuvant therapy for patients with locally advanced bladder cancer. The IAC showed improve DFS and OS in this study. (CLINICAL TRIALS.GOVIDENTIFIER: NCT01627197). Source of Funding: 5010 project of sun yat-sen university © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e843-e843 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lijuan Jiang More articles by this author Kai Yao More articles by this author Zike Qin More articles by this author Fangjian Zhou More articles by this author Zhuowei Liu* More articles by this author Expand All Advertisement PDF downloadLoading ...

Severe Periocular Edema after Intraarterial Carboplatin Chemotherapy for Retinoblastoma in a Rabbit (Oryctolagus cuniculus) Model

Endovascular microcatheter-based intraarterial (ophthalmic artery) chemotherapy is becoming widely used for the clinical treatment of intraocular retinoblastoma due to its apparent increased efficacy compared with traditional intravenous chemotherapy; however local ocular complications are not uncommon. Carboplatin is a chemotherapeutic agent used in both intravenous and intraarterial chemotherapy. We used rabbits to assess pharmacokinetics and ocular and systemic toxicity after intraarterial carboplatin infusion. Subsequent to unilateral intraarterial administration of carboplatin, severe unilateral or bilateral periocular edema occurred in 6 adult male New Zealand white rabbits. Time to onset varied from less than 4 h after administration (n = 3, 50 mg) to approximately 24 h afterward (n = 3, 25 mg). After becoming symptomatic, 5 of the 6 animals were promptly euthanized, and the remaining animal (25 mg treatment) was medically managed for 4 d before being euthanized due to intractable edema-related lagophthalmos. Globes and orbits from all 6 euthanized rabbits were harvested en bloc; whole-mount sections were prepared for histologic evaluation, which revealed drug-induced vasogenic edema in confined spaces as the main underlying pathogenesis. Transient and self-limiting periocular edema is a common side effect of intraarterial chemotherapy but is thought to occur predominantly with melphalan monotherapy or combination therapy using melphalan, carboplatin, and topotecan. The severity of this adverse consequence in rabbits was unexpected, and its use in the study was subsequently discontinued. Although the definitive cause for this vasotoxicity and striking clinical presentation is unknown, we suspect species-specific anatomic features and sensitivity might have contributed to amplified complications after intraarterial carboplatin chemotherapy of the eye. Due to the adverse effects of intraarterial carboplatin chemotherapy that we observed in 2 experimental cohorts of rabbits, we recommend caution regarding its use in this species.

Cardiotoxic Profile and Arterial Stiffness of Adjuvant Chemotherapy for Colorectal Cancer.

Background and PurposeEven though new cancer therapies have improved the overall survival, in some cases they have been associated with adverse effects, including increased cardiotoxicity. The purpose of the present study was to assess the cardiovascular effects of adjuvant chemotherapy for colorectal cancer and mainly the impact on arterial stiffness indices.Material and MethodsA total of 70 patients with non-metastatic colorectal cancer who were treated either with FOLFOX (n=16) or with XELOX (n=54) adjuvant chemotherapy were included in the study. All patients were subjected to full cardiovascular evaluation at the beginning and the end of chemotherapy. Arterial stiffness was assessed by means of pulse wave velocity (PWV) and augmentation index (Aix) and full laboratory examinations were conducted prior to, and soon after, the termination of chemotherapy.ResultsPatients exhibited significantly higher levels of carotid-radial PWV, carotid femoral RWV and Aix post-chemotherapy (p<0.001); these findings remained significant when examined separately in each treatment subgroup (FOLFOX, XELOX). The observed changes were independent of treatment regimen and baseline patient characteristics. Univariate regression analyses showed that baseline PWVc-r and PWVc-f were the only factors associated with PWVc-r and PWVc-f change, while Aix change was independent of its baseline value.ConclusionThere is a clear burden in arterial stiffness indices post-adjuvant chemotherapy for colorectal cancer in both chemotherapy groups. This is a finding of important clinical significance, however more prospective studies are required in order to encode the possible mechanisms involved.

Adjuvant hepatic arterial infusion pump chemotherapy after resection of colorectal liver metastases; results of a safety and feasibility study in the Netherlands

Adjuvant hepatic arterial infusion pump chemotherapy after resection of colorectal liver metastases; results of a safety and feasibility study in the Netherlands

Clinical analysis of 66 patients of retinoblastoma

Objective To observe the clinical characteristics of retinoblastoma (RB) in Southwest China. Methods A retrospective clinical study. From January 2010 to December 2017, 66 RB patients diagnosed in Ophthalmology Department of West China Hospital of Sichuan University were included in the study. All the patients underwent ocular B-ultrasound, orbital CT or MRI examination. Ten patients underwent RetCam examination at the same time. Twenty-nine patients were diagnosed by histopathological examination, and 37 patients were diagnosed by clinical symptoms and imaging examination. According to whether the tumor invaded the orbit and optic nerve, it could be divided into extraocular stage and intraocular stage. Intraocular tumors were divided into A-E stages according to the international intraocular RB classification. Treatments were performed according to different stages. The general information, age at diagnosis, course of diseases (the time between onset symptoms and diagnosis), causes of visiting a doctor, classification, treatment methods and eyeball preservation rate were retrospectively analyzed. Results Patients all came from Southwest China (56 patients from Sichuan Province, 2 patients from Yunnan Province, 2 patients from Guizhou Province, and 6 patients from Tibet). The permanent residence were identified in 43 patients, including 27 patients (62.8%) from rural areas. There were 38 males (57.6%); 50 unilateral tumors (75.8%) and 16 bilateral tumors (24.2%); 51 first-visiting patients (77.3%) and 15 re-visiting patients (22.7%). The average diagnostic age of first-visiting patients was 20.9±14.4 months, with 23.2±14.7 and 11.2±7.6 months for unilateral and bilateral tumors, respectively. There were 41 patients had definite course and causes, of whom the average course was 90.6±115.2 days. The most common cause was leucocoria in 32 patients (62.7%), followed by redness and swelling in 4 patients (9.8%), and other causes in 5 patients (12.2%). Among the 15 re-visiting patients, the average diagnostic age was 63.6±46.8 months, the average course was 32.8±45.5 months. Recurrence was occurred in 5 patients (33.3%), leucocoria in 4 patients (26.7%), postoperative complication in 3 patients (20.0%), protrusion in 2 patients (13.3%) and redness in 1 (6.7%) patient, respectively. Fifty out of 82 eyes were admitted to hospital, including 37 eyes of first-visiting patients and 13 eyes of re-visiting patients. Among 37 first-visiting eyes, there were 5 eyes (13.5%) in stage A-C, 26 eyes (70.3%) in stage D-E, 6 eyes (16.2%) in extraocular stage. Five eyes in stage A-C were treated with laser photocoagulation and (or) cryotherapy combined with systemic chemotherapy. Four eyes in stage D were treated with intraocular arterial chemotherapy. Nineteen eyes (51.3%) were performed with enucleation, 2 eyes (5.4%) with evisceration and 7 eyes (18.9%) abandoned treatment. Among 13 re-visiting eyes, 6 eyes (46.2%, with 5 eyes of recurrence) had been enucleated before, 4 eyes (30.8%) were in extraocular stage and 3 eyes (23.1%) in stage D-E. Five eyes (38.5%) were treated with evisceration, 4 eyes (30.8%) with enucleation, 1 eye with oculoplastic surgery and 3 eyes (23.1%) abandoned treatment. The rate of eye preservation was 18.0%, 29.0% for intraocular stage and 0% for extraocular stage, respectively. Conclusion RB patients in Southwest China have a longer course between onset symptoms and diagnosis, more advanced classification and lower rate of eye preservation. Key words: Retinoblastoma; Disease attributes; Chemotherapy, cancer, regional perfusion; Laser coagulation; Cryotherapy

Hepatic arterial infusion pump chemotherapy combined with systemic therapy for patients with advanced colorectal liver metastases: Outcomes in a newly established program

Presenter: Brett Walker MD | Oregon Health and Science University Background: Metastatic disease to the liver is a leading cause of morbidity and mortality in patients with colorectal cancer, with the majority of patients presenting with initially unresectable disease. Although hepatic resection offers the best chance of cure for colorectal liver metastases (CRLM), 40% of patients will develop intrahepatic recurrence not amenable to additional hepatic resection. Hepatic arterial infusion (HAI) chemotherapy with floxuridine has been demonstrated to improve survival in patients with resected CRLM and can be integrated with systemic therapy to convert patients with technically unresectable disease to a resectable status. Herein, we describe the experience of a recently established multidisciplinary hepatic arterial infusion program for the treatment of patients with advanced CRLM at an NCI Comprehensive Cancer Center. Methods: Between 2016 and 2018, n=22 consecutive patients had a HAI pump placed as part of their multidisciplinary treatment plan for advanced CRLM. All patients received systemic chemotherapy peri-operatively and concurrently with HAI. A multidisciplinary tumor board reviewed each HAI candidate before pump placement and throughout their therapy. Clinicopathologic data were collected and patient overall (OS) and progression-free (PFS) survival was assessed using the Kaplan-Meier method. Results: Over the 30-month period, 7 patients with resected CRLM and 15 patients with unresectable CRLM had an HAI pump operatively placed at a median of 6 months after diagnosis. The median age was 55 years (range: 32-67) and 59% (n=13) were women. The majority of patients had a high hepatic tumor burden (76% with >10 metastases) and received a median of 8 (range: 4-18) cycles of systemic chemotherapy, mostly commonly FOLFOX, prior to HAI pump placement (Table). Of the 12 patients with an intact primary cancer, 11 had simultaneous HAI pump placement with resection of their primary cancer. Only 1 patient experienced a major complication (Clavien-Dindo ≥ 3) within 30 days of their operation (small bowel obstruction from prior loop ileostomy procedure). 21 patients received at least one HAI cycle of floxuridine and had a median of 5 cycles (range: 1-10) before HAI therapy was discontinued or held after clearance of intrahepatic disease. In total, 32% (n=7) of patients developed pump related complications, with biliary sclerosis being the most common (n=5/21, 24%). Of the 13 patients treated to convert their initially unresectable disease, 3 patients (23%) underwent hepatic resection with curative intent after a median of 7 HAI cycles (range: 4-10) and achieved complete clearance of their hepatic disease. For all patients treated with HAI and systemic therapy, the median OS from diagnosis was 52 months (95%: IQR 43-64 months) and the median PFS from pump placement was 21 months (95%: IQR 17-31 months). Conclusion: HAI pump therapy with floxuridine can be used in combination with modern systemic chemotherapy for patients with advanced CRLM, both in the adjuvant setting and to facilitate conversion of unresectable disease in more than 20% of patients presenting with high liver disease burden. When implemented in a multidisciplinary program, HAI therapy is safe with low of peri-operative morbidity and promising outcomes in patients with limited treatment options.

Adjuvant hepatic arterial infusion pump chemotherapy after resection of colorectal liver metastases; a phase II trial

Introduction: Adjuvant hepatic arterial infusion pump (HAIP) chemotherapy demonstrated promising results with a median overall survival of 67 months (n=785) versus 44 months without HAIP (n=1.583, p<0.001) in a propensity scored analysis in patients with resectable colorectal liver metastases (CRLM).[J Clin Onc;35(17):1938] However, its general application is limited. Previous results from Memorial Sloan Kettering Cancer Center (MSKCC) should be confirmed in a randomized controlled trial (RCT) outside MSKCC. The aim of this study was to investigate the feasibility and safety of HAIP chemotherapy in a multicenter setting in the Netherlands. Materials & Methods: A phase II study was performed in two high-volume centers in the Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients were scheduled for 6 cycles of adjuvant HAIP chemotherapy with floxuridine, after complete resection of CRLM with pump placement. The main endpoints were feasibility (defined as successful administration of at least one cycle of HAIP chemotherapy) and safety (defined as 90-day postoperative complications). Result(s): Twenty patients with resectable CRLM were included. The median age of patients was 57 years (range 42-75). The median clinical risk score was 2 (range 1-5). All 20 patients (100%) received at least one dose of HAIP chemotherapy at a median of 42.5 days (range 26-57) after surgery. Pump related postoperative complications occurred in 2 patients (10%); replacement of a malfunctioning pump and repositioning of a flipped (upside down) pump. No arterial hemorrhage or dissection, extrahepatic perfusion, catheter related problems, pump pocket hematoma or pump pocket infections were found within 90-days after resection and implantation. Conclusion(s): Adjuvant HAIP chemotherapy in patients with resectable CRLM is safe and feasible as demonstrated in a phase II study of 20 patients. The PUMP trial (NTR 7493) has started to investigate the effectiveness of adjuvant HAIP chemotherapy in a randomized controlled trial.

The impact of hepatic arterial infusion pump chemotherapy on hepatic recurrences and survival in patients with resected colorectal liver metastases

BackgroundThe objective was to investigate the impact of adjuvant hepatic arterial infusion pump (HAIP) chemotherapy on the rates and patterns of recurrence and survival in patients with resected colorectal liver metastases (CRLM). MethodsRecurrence rates, patterns, and survival were compared between patients treated with and without adjuvant HAIP using competing risk analyses. Results2128 patients were included, of which 601 patients (28.2%) received adjuvant HAIP and systemic chemotherapy (HAIP + SYS). The overall recurrence rate was similar with HAIP + SYS or SYS (63.5% versus 64.2%,p = 0.74). The 5-year cumulative incidence of initial intrahepatic recurrences was lower with HAIP + SYS (22.9% versus 38.4%,p < 0.001). The 5-year cumulative incidence of initial extrahepatic recurrences was higher with HAIP + SYS (48.5% versus 40.3%,p = 0.005), because patients remained at risk for extrahepatic recurrence in the absence of intrahepatic recurrence, which was largely attributable to more pulmonary recurrences with HAIP + SYS (33.6% versus 23.7%,p < 0.001). HAIP was an independent prognostic factor for DFS (adjusted HR 0.69, 95% CI 0.60–0.79, p < 0.001), and OS (adjusted HR 0.67, 95% CI 0.57–0.78,p < 0.001). ConclusionAdjuvant HAIP chemotherapy is associated with lower intrahepatic recurrence rates and better DFS and OS after resection of CRLM.

Endoarterial Treatment in Combination With Percutaneous Thermoablation for Medium-sized and Oligonodular Hepatocellular Carcinomas

Background & Aims: The association of transcatheter arterial chemotherapy infusion (TAC) with percutaneous ablation (PT) has been introduced as a method to increase the size of the ablative zone and treat satellites micronodules. The aim of this study was to evaluate the efficacy of PT and TAC performed in a single session for hepatocellular carcinomas (HCCs) between 30 and 50 mm or oligonodular HCC up to 30 mm. Methods: Thirty patients with a histologically proven HCC, uninodular between 30 and 50 mm or oligonodular (n≤3) up to 30 mm, treatment-naive and non-metastatic, received the combination treatment (“PT+TAC group”). A “control” group consisted of 34 patients with uninodular HCC up to 30 mm without any poor prognostic criteria treated with PT alone (“PT group”). Results: The majority of patients were cirrhotic (90% vs 91%, respectively for the PT+TAC and PT groups), Child-Pugh A (83% vs 85%), with a Performans Status of 0 (80% vs 79%). There was no significant difference in the median alpha-fetoprotein level (15 vs 9.3 μg/l, p=0.39). The 1-, 3-, and 5-year OS was no significantly different in both groups: 100%, 82% and 48.5% in the PT+TAC group vs 94.1%, 72.7% and 65.2% in the PT group (p=0.88). The 1-, 3-, and 5-year relapse-free survival was significantly lower in the PT+TAC group: 59.3%, 18.5% and 5.6% vs 89.3%, 46.4% and 24.5%, in the PT group (p=0.02). Conclusion: The combination treatment for HCC between 30 and 50 mm or oligonodular up to 30 mm, showed a similar OS, compared to uninodular HCC up to 30 mm without poor prognostic criteria, treated with PT alone, at the price of earlier tumor recurrence.

Prognostic value of des-γ-carboxy prothrombin in patients with hepatocellular carcinoma treated with transarterial chemotherapy: A systematic review and meta-analysis.

BackgroundSerum des-γ-carboxy prothrombin (DCP) is a hepatocellular carcinoma (HCC) tumor marker that can be used to assess patient prognosis. Since the value of DCP in predicting the prognosis of hepatocellular carcinoma patients treated with transarterial chemotherapy remains controversial, we performed a meta-analysis of previous clinical studies.MethodsA systematic literature search was performed using PubMed, the MEDLINE database, EMBASE, and the Cochrane Library in accordance with the PRISMA guidelines. The hazard ratio (HR) with 95% confidence interval (CI) was used to estimate the effect size.ResultsSix respective cohort studies including a total of 943 cases were identified. The pooled results showed that low DCP was associated with a favorable overall survival (OS)(HR 0.653, 95% CI 0.444–0.960), and DCP response was associated with increased OS (HR 0.387,95% CI 0.215–0.697) and progression-free survival (PFS) (HR 0.42,95% CI 0.23–0.74) in HCC patients treated with transarterial chemotherapy.ConclusionsDCP values in HCC patients undergoing hepatic arterial chemotherapy seem to be associated with OS and PFS. Thus, monitoring DCP values and observing the DCP response should be part of the management of patients undergoing transarterial chemotherapy.

Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands

BackgroundThe 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs.Study DesignA phase II study was performed in two centers in The Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, grade III or higher) and feasibility by the successful administration of the first cycle of HAIP chemotherapy.ResultsA total of 20 patients, with a median age of 57 years (interquartile range [IQR] 51–64) were included. Grade III or higher HAIP-related postoperative complications were found in two patients (10%), both of whom had a reoperation (without laparotomy) to replace a pump with a slow flow rate or to reposition a flipped pump. No arterial bleeding, arterial dissection, arterial thrombosis, extrahepatic perfusion, pump pocket hematoma, or pump pocket infections were found within 90 days after surgery. After a median of 43 days (IQR 29–52) following surgery, all patients received the first dose of HAIP chemotherapy, which was completed uneventfully in all patients.ConclusionPump implantation is safe, and administration of HAIP chemotherapy is feasible, in patients with resectable CRLMs, after training of a dedicated multidisciplinary team.

Efficacy of combined modality therapy with sorafenib following hepatic arterial injection chemotherapy and three-dimensional conformal radiotherapy for advanced hepatocellular carcinoma with major vascular invasion.

The prognosis of hepatocellular carcinoma (HCC) patients exhibiting macroscopic vascular invasion (MVI) is poor, and the most appropriate treatment approach remains unclear. The current study aimed to investigate the efficacy and safety of sorafenib treatment following chemoradiotherapy for advanced HCC exhibiting MVI. A newly reported regimen, including 5-fluorouracil and cisplatin therapy (NewFP), plus three-dimensional conformal radiotherapy (3D-CRT) for MVI was used as the initial treatment. Additionally, sorafenib, as a secondary treatment, was administered after NewFP plus 3D-CRT for MVI. The present retrospective study enrolled patients with unresectable advanced HCC that was treated with NewFP plus 3D-CRT for MVI between January 2009 and December 2017. In total, 32 HCC patients with MVI were registered. Of these 32 patients, 18 were treated with NewFP plus 3D-CRT for MVI (NewFP + 3D-CRT group) and 14 were treated with sorafenib following NewFP plus 3D-CRT for MVI (sorafenib after NewFP + 3D-CRT group). The study endpoints were overall survival, overall response rate and disease control rate. Clinical factors influencing overall survival were identified using univariate and multivariate analyses. The median survival time in the NewFP + 3D-CRT group and sorafenib following NewFP + 3D-CRT group was 6.7 and 49.2 months, respectively (P=0.0003). For patients with advanced HCC exhibiting MVI, the initial treatment with NewFP plus 3D-CRT for MVI was well tolerated. The administration of sorafenib as the secondary treatment following NewFP plus 3D-CRT for MVI was associated with a significantly higher overall response rate, disease control rate and increased overall survival as compared with the NewFP plus 3D-CRT treatment.

Risk Factor for Residue After Uterine Artery Chemotherapy and Embolization in Combination with Dilatation and Curettage for Treating Caesarean Scar Pregnancy.

ObjectiveWe aimed to investigate the potential risk factors for residual lesions after uterine artery chemotherapy and embolization (UACE) in combination with dilatation and curettage (D&C) in patients with cesarean scar pregnancy (CSP).SettingsRetrospective case-control study.MethodUnivariate analysis and logistic analysis were applied to analyze these data to assess the risk factor of residue after UACE in combination with D&C.ResultsGestational age, human chorionic gonadotropin (HCG) level, and the gestation sac (GS) evagination to the bladder were the risk factors for the postoperative lesion. The most relevant was GS evagination to the bladder, followed by the preoperative HCG level and the gestational age. We defined the cut-off value of gestational age as 28 days with a sensitivity and specificity of 100 and 0, respectively.ConclusionIn cases with GS evagination to bladder and HCG of >28,113.65 mIU/ml as well as a gestational age of >28 days, the possibility of residual lesions was high.

Life-Threatening Complications During Superselective Ophthalmic Arterial Chemotherapy for Retinoblastoma: Retrospective Cohort Study

Background. Retinoblastoma is the most common intraocular malignant tumor in children. Substantial advances have been made in field of local treatment, in particular, through the development of selective intraarterial chemotherapy (SIAC). Life-threatening cardio-respiratory disorders were reported during the course of SIAC at the moment of a.ophthalmica catheterization. Objective. Our aim was to improve the safety and effectiveness of anesthetic management in children with retinoblastoma. Methods. The retrospective study included patients (n=203) who underwent SIAC (517) under general anesthesia in 2013–2018. Results. Hemodynamic parameters in patients who underwent SIAC procedure for the first time (211) were analyzed, in 186 (88%) cases, smooth anesthesia was observed, the deviations of blood pressure and heart rate did not exceed 20% of the baseline values. In 25 (12%) cases, patients who underwent the first SIAC procedure developed bronchospasm with a decrease in respiratory volume of up to 30% from the initial values 10–20 seconds after catheterization of a.ophthalmica with microcatheter. When analyzing hemodynamic parameters in patients who underwent repeated SIAC procedures (2nd, 3rd sessions, etc.) (306), in 177 (58%) cases, a clinical picture of the trigemino-pulmonary reflex of varying severity manifested. Conclusion. Severe cardio-respiratory complications are often observed during SIAC in children with retinoblastoma. These reactions occur predominantly during the second or subsequent procedures and can be potentially life-threatening. All patients with retinoblastoma who undergo SIAC should be considered at high risk.

Adjuvant hepatic arterial infusion pump chemotherapy and resection versus resection alone in patients with low-risk resectable colorectal liver metastases \u2013 the multicenter randomized controlled PUMP trial

BackgroundRecurrences are reported in 70% of all patients after resection of colorectal liver metastases (CRLM), in which half are confined to the liver. Adjuvant hepatic arterial infusion pump (HAIP) chemotherapy aims to reduce the risk of intrahepatic recurrence. A large retrospective propensity score analysis demonstrated that HAIP chemotherapy is particularly effective in patients with low-risk oncological features. The aim of this randomized controlled trial (RCT) --the PUMP trial-- is to investigate the efficacy of adjuvant HAIP chemotherapy in low-risk patients with resectable CRLM.MethodsThis is an open label multicenter RCT. A total of 230 patients with resectable CRLM without extrahepatic disease will be included. Only patients with a clinical risk score (CRS) of 0 to 2 are eligible, meaning: patients are allowed to have no more than two out of five poor prognostic factors (disease-free interval less than 12 months, node-positive colorectal cancer, more than 1 CRLM, largest CRLM more than 5 cm in diameter, serum Carcinoembryonic Antigen above 200 μg/L). Patients randomized to arm A undergo complete resection of CRLM without any adjuvant treatment, which is the standard of care in the Netherlands. Patients in arm B receive an implantable pump at the time of CRLM resection and start adjuvant HAIP chemotherapy 4–12 weeks after surgery, with 6 cycles of floxuridine scheduled. The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall survival, hepatic PFS, safety, quality of life, and cost-effectiveness. Pharmacokinetics of intra-arterial administration of floxuridine will be investigated as well as predictive biomarkers for the efficacy of HAIP chemotherapy. In a side study, the accuracy of CT angiography will be compared to radionuclide scintigraphy to detect extrahepatic perfusion. We hypothesize that adjuvant HAIP chemotherapy leads to improved survival, improved quality of life, and a reduction of costs, compared to resection alone.DiscussionIf this PUMP trial demonstrates that adjuvant HAIP chemotherapy improves survival in low-risk patients, this treatment approach may be implemented in the standard of care of patients with resected CRLM since adjuvant systemic chemotherapy alone has not improved survival.Trial registrationThe PUMP trial is registered in the Netherlands Trial Register (NTR), number: 7493. Date of registration September 23, 2018.

Transarterial Chemoembolization (TACE) with Lipiodol� in HCC PatientsTechnical, clinical and imagistic aspects

Hepatocellurar carcinoma (HCC) is the most frequent primary hepatic tumor, the vast majority of patients have less than a 12 month survival rate. The aim of this study was to evaluate the efficacy of TACE in patients with HCC, based on a case series and literature review. The study included 12 consecutive patients with HCC who underwent surgical treatment (resection, liver transplantation � resection) at the Department of Transplantation and Surgery, Semmelweis University, Budapest, during 2009-2015. All the patients received at least one TACE session. Patients with BCLC B-stage who benefit from TACE and another alternative therapy (eg, RFA) may be associated with or exhibit tumor stagnation, or tumor necrosis in most cases. In C BCLC stages, desperate cases - the two patients to whom TACE was the last therapeutic attitude, despite the predicted prognosis, TACE assured the prolongation of life and increased life quality. In the majority of patients in this study, stage A BCLC, chemoembolization was a therapeutic attitude that allowed subsequent liver transplantation (when it was not feasible initially due to tumor size) or liver resection in apparently inoperable cases. The arterial chemotherapy is the unanimously accepted indication in patients with stage B, BCLC. The data presented encourages us to opt for TACE with the intention of destaging BCLC and giving an operability character to the hepatic tumors (resection � hepatic transplantation). In stage C BCLC, TACE can be a last attempt to improve the quality of life and to control tumor progression.

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the history, technique, indications, contraindications, and outcome of IAC. We have also identified the strengths, weaknesses, opportunities and threats (SWOT analysis) of the technique in this review.

Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children

BackgroundClear cell sarcoma of the kidney (CCSK) is a rare and aggressive malignant renal tumor. We describe our experience with neoadjuvant transcatheter arterial chemoembolization (TACE) and systematic chemotherapy for the treatment of advanced CCSK in children. MethodsBetween January 2010 and December 2016, seven patients (3 boys and 4 girls; median 2.2 years) with advanced CCSK received preoperative TACE of renal artery and systemic chemotherapy. The chemoembolic emulsion for TACE consisted of cisplatin, pirarubicin, vindesine, and iodized oil. Preoperative systemic chemotherapy with vindesine, ifosfamide, and etoposide was administered three weeks after TACE. Nephrectomy was performed three weeks after systemic chemotherapy. After surgery, patients received radiotherapy and postoperative chemotherapy. ResultsNo cardiotoxicity, renal insufficiency, or hepatic dysfunction was found in any patients. Grade II–III marrow suppression developed in four patients. One patient with tumor progress during neoadjuvant therapy failed to successfully undergo surgery and died. Six patients underwent nephrectomy after neoadjuvant therapy. Median follow-up period was 49.5 months (range, 11–83 months). Five patients have recurrence-free survival. One patient is still in postoperative chemotherapy after nephrectomy, radiotherapy and thoracoscopic resection of lung metastases. ConclusionsNeoadjuvant TACE and systemic chemotherapy appeared to be feasible in the treatment of advanced CCSK in this pilot study. The type of studyA case series with no comparison group. Level of evidenceLevel IV.

Postoperative hepatic arterial chemotherapy in high-risk patients as adjuvant treatment after resection of colorectal liver metastases - a randomized phase II/III trial \u2013 PACHA-01 (NCT02494973)

BackgroundAfter curative-intent surgery for colorectal liver metastases (CRLM), liver recurrence occurs in more than 60% of patients, despite the administration of perioperative or adjuvant chemotherapy. This risk is even higher after resection of more than three CRLM. As CRLM are mostly supplied by arterial blood flow, hepatic arterial infusion (HAI) of chemotherapeutic agents after resection of CRLM is an attractive approach. Oxaliplatin-based HAI chemotherapy, in association with systemic fluoropyrimidines, has been shown to be safe and highly active in patients with CRLM. In a retrospective series of 98 patients at high risk of hepatic recurrence (≥4 resected CRLM), adjuvant HAI oxaliplatin combined with systemic chemotherapy was feasible and significantly improved disease-free survival compared to adjuvant, ‘modern’ systemic chemotherapy alone.Methods/DesignThis study is designed as a multicentre, randomized, phase II/III trial. The first step is a non-comparative randomized phase II trial (power, 95%; one-sided alpha risk, 10%). Patients will be randomly assigned in a 1:1 ratio to adjuvant systemic FOLFOX (control arm) or adjuvant HAI oxaliplatin plus systemic LV5FU2 (experimental arm). A total 114 patients will need to be included. The main objective of this trial is to evaluate the potential survival benefit of adjuvant HAI with oxaliplatin after resection of at least 4 CRLM (primary endpoint: 18-month hepatic recurrence-free survival rate). We also aim to assess the feasibility of delivering at least 4 cycles of HAI (or i.v.) oxaliplatin after surgical treatment of at least 4 CRLM, the toxicity (NCI-CTC v4.0) of adjuvant HAI plus systemic chemotherapy, including HAI catheter-related complications, compared to systemic chemotherapy alone, and the efficacy of adjuvant HAI on hepatic and extra-hepatic recurrence-free (survival and overall survival).DiscussionIf 18-month hepatic recurrence-free survival is greater than 50% in the experimental arm, the study will be pursued in phase III, for which the primary endpoint will be 3-year recurrence-free survival rate. Patients randomized in the phase II will be included in the phase III, with an additional number of 106 patients.Trial registrationClinicalTrials.gov, NCT02494973. Trial registration date: July 10, 2015.