Infusion Of Chemotherapeutic Agents Research Articles

Serpentine Supravenous Hyperpigmentation, a Phenomenon Following the Administration of Chemotherapeutic Agents: A Systematic Review.

Serpentine supravenous hyperpigmentation (SSH) is known as a phenomenon occurring during the infusion of chemotherapy agents in the underlying veins. Chemotherapy agents have potential to cause infusion reactions when used systematically. Linear hyperpigmentation and reticular hyperpigmentation are the differential diagnosis for this phenomenon. The aim of the present study was to systematically review the serpentine supravenous dermatitis induced by chemotherapeutic agents. A comprehensive search was conducted in Scopus, PubMed, Embase, and Web of Science bibliometric databases on February 7, 2023. The search keywords were categorized into two groups: SSH and chemotherapy. Any combination between keywords was used for the systematic search. We included any type of article that evaluated the SSH in cancer patients after the infusion of chemotherapeutic agents, including observational studies with at least one eligible patient based on our criteria, case series, and case reports. Studies that reported SSH in non-cancer patients or caused by any medications other than chemotherapeutic agents were excluded. Twenty-five studies were included based on our inclusion criteria consisting of 26 patients. A total of 13 different cancers were reported in the included studies. Lung cancer was the most reported cancer. Also, the mostly reported region of this dermatitis was forearm which was reported in 13 studies. Docetaxel has been used in a total of 11 articles in this study and has independently induced serpentine supravenous dermatitis in seven studies, which is the mostly reported chemotherapeutic agent resulting into serpentine supravenous dermatitis. Most of these skin lesions were self-limiting and with a normal histopathological finding. SSH is a dermatologic reaction, which mostly occur when there is peripheral venous access for the injection of chemotherapeutic agents. The skin lesion will improve spontaneously and have a benign course with no abnormal histopathological pathological finding.

Malignant Intracranial High Grade Glioma and Current Treatment Strategy.

Malignant high-grade glioma (HGG) is the most common and extremely fatal type of primary intracranial tumor. These tumors recurred within 2 to 3 cm of the primary region of tumor resection in the majority of cases. Furthermore, the blood-brain barrier significantly limited the access of many systemically administered chemotherapeutics to the tumor, pointing towards a stringent need for new therapeutic patterns. Therefore, targeting therapy using local drug delivery for HGG becomes a priority for the development of novel therapeutic strategies. The main objectives to the effective use of chemotherapy for HGG include the drug delivery to the tumor region and the infusion of chemotherapeutic agents into the vascular supply of a tumor directly, which could improve the pharmacokinetic profile by enhancing drug delivery to the neoplasm tissue. Herein, we reviewed clinical and molecular features, different methods of chemotherapy application in HGGs, especially the existing and promising targeting therapies using local drug delivery for HGG which could effectively inhibit tumor invasion, proliferation and recurrence of HGG to combat the deadly disease. Undoubtedly, novel chemical medicines targeting these HGG may represent one of the most important directions in the Neuro-oncology.

EFFECTS OF NEW TECHNIQUE ON ORAL MUCOSITIS

Cancer and chemotherapy are amongst leading health problems influencing the quality of life of the individual. The complications of many treatment regimens appear frequently in the mouth, and cause serious problems. Although mucositis has been a subject of interest to scientists for more than 20 years, this has not resulted in development of standard procedures for prevention and management. The aim of this study was to examine the effect of oral cryotherapy on the development of mucositis in patients receiving Chemotherapy. This quasi experimental study was conducted at the respiratory disease clinic, at the National Cancer Institute in Cairo on 60 patients with bronchogenic carcinoma under chemotherapy; 30 randomly allocated to study group with oral cryotherapy, and 30 allocated to the control group. Data collection tools included demographic data sheet, patient-judged mucositis grading, physician-judged mucositis grading, and oral pH measurement. Data were collected before the first chemotherapy course, and for 21 days. Physician-judged mucositis was done on days 2, 3, and 21. Oral pH measurements were done on days 1, 2, 3, and 21 using Merck Universal Indicator. Cryotherapy was done using special ice cubes with rounded corners. Patient-judged mucositis grading was highest on day 6 in the study (40.0%) and control (80.0%) groups, The differences between the study and control groups in the changes in pH values after chemotherapy were statistically significant at the four days of assessment, p < 0.001. It is concluded that oral cryotherapy shifts the pH of saliva to alkaline, and thus can prevent mucositis development and it's severity in patients undergoing chemotherapy. Therefore, it is recommended that oral cryotherapy be initiated five minutes before infusion and maintained during infusion of chemotherapeutic agents that can cause mucositis, with further research to study the effect of oral cryotherapy in subsequent courses of chemotherapy

EFFECTS OF NEW TECHNIQUE ON ORAL MUCOSITIS

Cancer and chemotherapy are amongst leading health problems influencing the quality of life of the individual. The complications of many treatment regimens appear frequently in the mouth, and cause serious problems. Although mucositis has been a subject of interest to scientists for more than 20 years, this has not resulted in development of standard procedures for prevention and management. The aim of this study was to examine the effect of oral cryotherapy on the development of mucositis in patients receiving Chemotherapy. This quasi experimental study was conducted at the respiratory disease clinic, at the National Cancer Institute in Cairo on 60 patients with bronchogenic carcinoma under chemotherapy; 30 randomly allocated to study group with oral cryotherapy, and 30 allocated to the control group. Data collection tools included demographic data sheet, patient-judged mucositis grading, physician-judged mucositis grading, and oral pH measurement. Data were collected before the first chemotherapy course, and for 21 days. Physician-judged mucositis was done on days 2, 3, and 21. Oral pH measurements were done on days 1, 2, 3, and 21 using Merck Universal Indicator. Cryotherapy was done using special ice cubes with rounded corners. Patient-judged mucositis grading was highest on day 6 in the study (40.0%) and control (80.0%) groups, The differences between the study and control groups in the changes in pH values after chemotherapy were statistically significant at the four days of assessment, p < 0.001. It is concluded that oral cryotherapy shifts the pH of saliva to alkaline, and thus can prevent mucositis development and it's severity in patients undergoing chemotherapy. Therefore, it is recommended that oral cryotherapy be initiated five minutes before infusion and maintained during infusion of chemotherapeutic agents that can cause mucositis, with further research to study the effect of oral cryotherapy in subsequent courses of chemotherapy

Implante de Port-o-Cath para quimioterapia antineoplásica em um canino: relato de caso

RESUMO O Port-o-Cath é um cateter venoso central totalmente implantável, o qual permite a infusão de quimioterápicos, hemoderivados, nutrição parenteral e coleta de sangue. Este trabalho relata o caso de um canino com um tumor no membro pélvico que foi tratado cirurgicamente e recebeu o cateter para a quimioterapia antineoplásica. A paciente possuía um sarcoma sinovial, tumor incomum em cães, que acomete normalmente as articulações e exige terapia multimodal. O tratamento foi feito em duas etapas; na primeira, o membro foi amputado e, na segunda, foi realizado o implante do Port-o-Cath e exérese de nódulo metastático. A cadela respondeu satisfatoriamente à cirurgia e realizou as sessões de quimioterapia com perfeito funcionamento do cateter, indo a óbito por outras causas 90 dias após o procedimento. O implante de Port-o-Cath para a quimioterapia é um grande aliado à terapia multimodal preconizada para o câncer, podendo o cateter ser considerado em pacientes que necessitem de medicação quimioterápica por longo período.

TACE vs DEB-TACE: Who wins?

Transarterial chemoembolization (TACE) is the recommended reatment modality for patients with intermediate stage hepatoellular carcinoma (HCC), or stage B as defined by the Barcelona linic Liver Cancer (BCLC) classification system [1]. According to he EASL/EORTC clinical practice guidelines for the management f HCC, the use of TACE is indicated in patients with unresectable, ultinodular cancers who are asymptomatic and do not display vidence of vascular invasion or extrahepatic spread of the tumour 2]. The rationale behind the use of TACE is based on the concept hat, since HCC growth is characterized by a marked increase in rterial neovascularization, the selective intra-arterial infusion of chemotherapeutic agent to be delivered in proximity of tumour odules, followed by the permanent embolization of the arterial essel supporting the blood supply, would determine both a cytooxic and an ischaemic effect, leading to tumoral necrosis. Studies ave shown that the combination of a chemotherapeutic agent with n ischaemic agent exerts greater effects compared to chemotherpy alone, although debate remains about the effectiveness of rterial embolization alone [3]. Conventional TACE (c-TACE) is based on the use of different hemotherapeutic agents, most commonly doxorubicin, epirubicin, r mytomycin. TACE is seldom curative in patients with intermedite HCC, but several randomized controlled trials (RCT) have shown ts use to be associated with delayed tumoral progression, reduced ascular invasion, and improved patient survival, with an averge life gain of 4 months (i.e., from a median survival of 16–20 onths) [4]. These favourable data, despite being disputed by a ecent Cochrane review [5], have driven the current EASL/EORTC uidelines, recommending the use of TACE in patients with interediate (BCLC stage B) HCC. Notably, this recommendation has een established by the highest level, both for the supporting evience as for the strength of recommendation. Yet, several questions remain unanswered about the use of ACE. First, TACE is not a standardized procedure: it is still unclear hich is the preferred chemotherapeutic agent to be used, the ost appropriate size of the embolizing particles, and the maxium number and the timing of procedures that can be performed. econd, there is a clear need to better select the patient population eserving TACE treatment, as patients with previous decompen-

Cutaneous Metastasis of Hepatocellular Carcinoma Following Skin Injury after Transcatheter Arterial Chemoembolization

Dear Editor: Transcatheter arterial chemoembolization (TACE) is widely used as an approach for patients with hepatocellular carcinoma (HCC). Cutaneous complications related to TACE such as erythema, necrosis, and scarring may rarely occur1. This report describes the first known case of cutaneous metastasis of HCC following skin injury after TACE. A 39-year old man had been diagnosed with HCC in January 2010. On the initial computed tomography (CT) image, a 7.8 cm sized tumor was noted. The patient was treated with TACE from February 2010 via the femoral artery. On a follow-up CT in May 2010, the tumor size decreased, however, daughter nodules were noted. The 7th TACE was performed via the internal mammary artery (IMA) due to the presence of collateral pathways. In November 2010, an 8th course of TACE of the IMA was performed. However, an erythematous to violaceous patch developed shortly after the infusion of chemotherapeutic agents and resulted in pigmentation and induration. In January 2011, the patient was referred to the dermatology clinic with two erythematous papules on the right chest that developed at the end of December 2010 (Fig. 1). The papules had developed within the pigmented induration, which was associated with skin injury after the TACE in November 2010. Fig. 1 Two, asymptomatic, erythematous papules and underlying pigmentation and wood plate-like induration on the right chest. Histopathologic examination of the erythematous papule showed asymmetrical, lobulated nests invading the dermis (Fig. 2A). The large cells had a polyhedral shape, eosinophilic cytoplasm, large central nuclei and prominent nucleoli (Fig. 2B). The specimen was negative for AFP (Fig. 2C). CD31 stain did not show evidence of hematogenous spread of tumor nests (Fig. 2D). Fig. 2 (A) Asymmetrical, lobulated cords and nests invading the dermis (H&E, ×40). (B) The large epithelial cells of polyhedral shape showed granular, eosinophilic cytoplasm, large, vesicular, central nuclei and prominent nucleoli (H&E, ... As the papules occurred on the scar and a series of examinations showed no other metastasis, the lesions were thought to be associated with the skin injury after TACE. The biopsy specimen was negative for AFP. However, positive staining for AFP has been reported to be present in 2 to 61% of HCC2. Expression of AFP can be weak, especially in small biopsies. Tumor seeding of HCC after interventional procedures is a rare complication. Cutaneous tumor seeding of HCC along the tract of the needle used in the diagnosis has been reported3. The frequency of needle tract implantation after radiofrequency ablation ranges from 0 to 4.4%.3 Iatrogenic cutaneous tumor seeding by ultrasound-guided percutaneous ethanol injection has also been rarely reported4. TACE via the IMA may be performed when collateral pathways are evident. Repetitive TACEs or large tumor sizes may be associated with the presence of collateral pathways. In our case, TACE-induced injury may have caused inflammatory changes or adhesion of the chest wall that helped the progression of the residual viable tumor along the liver surface to the skin. Adhesion between the HCC and other tissues including vessels such as the peritoneum and/or omentum after TACE has been shown in a laparoscopic study5. We have presented a case of cutaneous metastasis from HCC following skin injury after TACE that was thought to be relevant to the cutaneous complication of the chemoembolization procedure. The potential cutaneous complications of TACE must be taken into consideration.

Outbreak of Pseudomonas fluorescens bacteremia among oncology patients.

From 7 to 24 March 1997, four patients developed Pseudomonas fluorescens bacteremia at the hospital; one on the oncology ward and the other three in the chemotherapy room. These patients all had underlying malignancies and had the Port-A-Cath (Smiths Industries Medical Systems, Deltec, Inc., St. Paul, Minn.) implants. Three patients had primary bacteremia, and one had Port-A-Cath-related infection. None of these patients had received a blood transfusion before the episodes of bacteremia. All patients recovered: two received antimicrobial agents with in vitro activity against the isolates, and the other two did not have any antibiotic treatment. A total of eight blood isolates were recovered from these patients during the febrile episodes that occurred several minutes after the infusion of chemotherapeutic agents via the Port-A-Cath. These isolates were initially identified as P. fluorescens or Pseudomonas putida (four), Burkholderia (Ralstonia) pickettii (three), and a non-glucose-fermenting gram-negative bacillus (one) by routine biochemical methods and the Vitek GNI card. These isolates were later identified as P. fluorescens on the basis of the characteristic cellular fatty acid chromatogram and the results of supplemental biochemical tests. The identification of identical antibiotypes by the E test and the random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates showed that the outbreak was caused by a single clone of P. fluorescens. Surveillance cultures of the possibly contaminated infusion fluids and disinfectants, which were performed 7 days after recognition of the last infected patient, failed to isolate P. fluorescens. This report of a small outbreak caused by P. fluorescens suggests that timely, accurate identification of unusual nosocomial pathogens is crucial for early initiation of an epidemiological investigation and timely control of an outbreak.

Bronchial artery infusion of chemotherapeutic agents plus external irradiation in the treatment of advanced lung cancer —A report of 37 cases

Bronchial artery infusion of chemotherapeutic agents plus external irradiation in the treatment of advanced lung cancer —A report of 37 cases

Interventional procedures used for diagnosing and treating lung cancer

In recent years interventional radiology has played an increasingly important role in the diagnosis and treatment of lung cancer. Useful interventional procedures include biopsy techniques, direct infusion of chemotherapeutic agents into neoplasms, and a number of palliative procedures. The article reviews the indications, contraindications, techniques, and complications of these procedures with emphasis on some of the newer procedures.

Colorectal metastases to the liver

The management of patients with hepatic metastases from colorectal carcinoma is controversial. While a "no treatment" attitude still persists, other patients undergo systemic chemotherapy with very limited results. Other possible options are hepatic resection and locoregional treatments. One hundred twenty-three patients with hepatic metastases from colorectal cancer were treated at the authors' institution over a period of 15 years. Thirty-nine patients underwent hepatic resection while 84 underwent various forms of locoregional treatment. Several patients in the latter group were registered in one national (RNSI) Phase 2 study and one international (EORTC) Phase 3 trial. The authors' experience confirms the opinion that hepatic resection can be performed with the aim of curing in patients with isolated metastases. A five-year survival rate can be achieved in 25 to 30 percent of the resectable patients. Patients with unresectable extrahepatic disease or multiple bilateral metastases are usually excluded from resection. In other cases, hepatic resection should be carried out when technically possible. The value of adjuvant chemotherapy to the remaining liver has to be tested in prospective randomized trials. Patients with diffuse metastases can benefit from locoregional infusion of chemotherapeutic agents. Symptoms improve in most patients; objective responses vary from 53 to 83 percent of the cases, which is a higher rate than that reported for systemic chemotherapy. Survival may be prolonged in respect to untreated patients but this has not been demonstrated yet by prospective randomized studies. Current trends are continuous infusion of chemotherapeutic agents and experimentation of new drugs or drug combinations. Future improvements may be achieved by adding hepatic arterial ischemia, hyperthermia, or radiation therapy. As these kinds of treatments are still experimental, they should be applied to the patients only in the context of prospective clinical trials.

Slippery coaxial catheter system.

A slippery coaxial, 3-F catheter device was developed for selective angiography, embolization, and infusion of chemotherapeutic agents. The device comprises three parts: an 0.018-inch, plastic-coated guide wire; a 3-F coaxial catheter; and a 6.5-F guiding catheter. Both the guide wire and coaxial catheter are coated with hydrophilic polymer, which becomes slippery when immersed in water. Experience with four patients indicates the new coaxial catheter device is capable of traversing tortuous vessels smoothly and safely, and it permits infusion of chemotherapeutic agents and 1-mm gelatin particles.

Intra-arterial chemotherapy for advanced bladder cancer.

The results of prolonged intra-arterial chemotherapy in 61 patients with locally advanced bladder cancer (T3-T4) are discussed. Regional internal iliac artery infusion of chemotherapeutic agents was done daily for 5 or 7 days at a rate of 1 to 3 ml/h over an 18-20-h period. The total dosages of each course were 60-120 mg/m2 adriamycin, 2.5-3.5 g/m2 5-fluorouracil (5-FU), 20-40 mg/m2 methotrexate or 30-50 mg/m2 cisplatin. At 3 to 4 weeks after the completion of infusional chemotherapy the results were evaluated, based on data from control cystoscopy and sonography. One patient (1.6%) was free of tumor; an objective response of greater than 50% reduction in tumor size occurred in 26 (42.7%) patients; 34 (55.7%) demonstrated objective responses of less than 50%. No further increase in tumor size during the management was detected. Hematuria, dysuria and urine infection were controlled and pain was relieved. The use of cytostatics and prolonged iliac artery catheterization did not incur any serious complications.

Long-term brachial artery catheterization: ischemic complications.

The brachial artery is not used for long-term catheterization and routine hemodynamic monitoring because a high incidence of ischemic complications is anticipated. However, in a review of 157 patients who had 225 percutaneous transbrachial hepatic artery catheters placed for infusion of chemotherapeutic agents, catheters remained in situ from 1 day to 14 months (median 68 days). One hundred seventy-three catheters (77%) were removed electively and 52 catheters (23%) were removed because of complications. Diminution or loss of the radial pulses occurred on insertion of 88 catheters (39.1%) and 16 of these (8%) were removed after 24 hours because ischemic symptoms developed. Subsequently, 25 other catheters (11.1%) were removed because of complications such as paresthesia, eight (3.5%); brachial artery thrombosis, four (1.7%); microembolization, three (1.3%); claudication, two (0.8%); and pseudoaneurysm, one (0.4%). Seven catheters (3.1%) were removed because of a combination of pallor, diminished pulses, and muscle weakness. Hemorrhage from the arteriotomy site necessitated the removal of 11 other catheters (4.9%). Amputation, ischemic ulceration, major neuromuscular sequelae, and peripheral embolization to the head or lower limbs did not occur. This study suggests that long-term brachial artery catheterization is associated with a low incidence of permanent ischemic complications.

Vascular diversion in chemotherapy of brain tumors

Of the patients with malignant gliomas treated by arterial infusion of chemotherapeutic agents at one institution, tumor extension beyond the territory supplied by a single internal carotid artery was documented at operation or by computed tomography or angiography in 55%. In 47% of the patients, a surgical procedure was performed to modify the cerebral circulation so that the entire lesion could be treated by infusing a single internal carotid artery. This report examines the anatomical and radiological background for these procedures, and the surgical options, techniques, and complications in this series of patients.

Hepatic arterial chemotherapy for colorectal cancer metastatic to the liver.

Hepatic metastases of colorectal origin are resistant to radiation and immunotherapy. Traditional intravenous chemotherapy produces responses in 10% to 30% of patients, and surgical resection is feasible in approximately 20% of patients who have a solitary or unilobar lesion. Infusion of cytotoxic agents into the hepatic artery, introduced 2 decades ago, is the most promising form of therapy for unresectable hepatic metastases. Fluorouracil, floxuridine, and mitomycin have been most commonly administered by hepatic arterial infusion. The recent development of a totally implantable pump has allowed prolonged ambulatory infusion of chemotherapeutic agents into the hepatic artery. We review the recent data on the pharmacology, therapeutic outcome, administration techniques, and complications of hepatic arterial chemotherapy. Future trials in this area should use uniform stratification variables and standardized criteria for evaluating response, time to progression, and survival.

Recurrent Cervical Cancer in the Pelvis — Intra-Arterial Infusion of Oncostatics —

Five cases of recurrent cervical carcinoma with sites of recurrence restricted to the pelvis were treated by intra-arterial infusion of oncostatics via the bilateral internal iliac arteries. One tip of the catheter was positioned in the internal iliac artery, proximal and close to the superior glutea artery, through the arteria glutea superior or inferior with ligations of both arteria glutea superior and inferior so as to give high concentration of drugs in the lesion. The other tip of the catheter was introduced subcutaneously up to the subclavian fossa of the anterior chest and was secured to the skin. Several chemotherapeutic agents (cisplatin, adriamycin, pepleomycin, mitomycin C and 5-fluorouracil) were infused repeatedly through the catheter, once or twice a week. The clinical efficacy according to Karnovsky's criteria was 0-C in one case, 1-A in one case and 1-B in three cases. The overall response rate of 1-B or higher was 60%. Two patients died, one from inflammation in the pelvic dead space and disseminated intravascular coagulopathy, the other from myocarditis and heart failure. The other three are alive and being treated by weekly intra-arterial infusion of chemotherapeutic agents at our outpatient clinic. No problems, such as spontaneous removal of the catheter, inflammation around the catheter or bleeding, have been encountered. The toxicity of the oncostatics in case of intra-arterial infusion was less pronounced than in the case of intra-venous administration of the same dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiographic appearance of recurrent malignant melanoma before and after intra-arterial chemotherapy.

Intra-arterial infusion of chemotherapeutic agents (CDDP alone or combined with DTIC) was used to treat recurrent melanoma in 22 patients. In 17 cases, sequential arteriograms were obtained before and after infusion to monitor the procedure. Pre-treatment angiograms usually demonstrated rounded nodules with a homogeneous, hypervascular stain. In 3 patients, additional deep-seated lesions which were not palpable clinically were detected by angiography. Arteriograms of those patients who responded to chemotherapy revealed partial or complete disappearance of tumor stain. A 46% response rate was observed. The authors feel that angiography is valuable in pre-treatment diagnosis and post-treatment evaluation of recurrent melanoma.

Transcatheter Occlusion of the Gastroduodenal Artery

The gastroduodenal arteries of 7 patients were occluded for treatment of duodenal bleeding in 4, hepatic devascularization in 2, and redistribution of blood flow for intra-arterial chemotherapy in one patient. In 6 patients, occlusion was performed with Gianturco coils, and with Gelfoam in one. No major complication was encountered. This approach was successful in the control of bleeding from peptic ulcers, arteriovenous malformation and invasion of duodenum by retroperitoneal metastatic lymph nodes from carcinoma of the testicle. Occlusion of the gastroduodenal artery was utilized for further dearterialization of hepatic neoplasms. Redistribution of hepatic blood flow was accomplished by the occlusion of the gastroduodenal and replaced right hepatic arteries allowing infusion of chemotherapeutic agents into the entire liver through the left hepatic artery.

Nonsystemic treatment of metastatic tumors of the liver--a review.

Hepatic metastasis is usually quite resistant to conventional systemic chemotherapy. Nonsystemic treatment of metastatic tumors of the liver include surgical resection; infusion of chemotherapeutic agent(s), either via hepatic artery or portal vein; ligation of hepatic artery; radiotherapy; and other more investigative approaches (isolation perfusion, cryosurgery, liver transplantation, etc). The relative applicability, results, and limitations of each of these therapeutic modalities are reviewed.