Intra-arterial Chemotherapy In Patients Research Articles

Intra-arterial Chemotherapy in Patients With Metastatic or Locally Aggressive Pancreatic Adenocarcinoma: A Scoping Review.

Pancreatic adenocarcinoma refers to cancer of the pancreatic duct cells. Itis normallydiagnosedwhen it is at an advanced stage, making the prognosis poor. Systemic chemotherapy is the primary treatment approach for locally advanced or metastatic pancreatic cancer and hasbeen shownto improve survivalby eight to 16 weeks. However, it does not directly penetrate malignant tissue and has many side effects, such as hair loss, bone marrow suppression, andmanygastrointestinal issues. A newer treatment modality,regional intra-arterialchemotherapy (IAC), focuses on targeting malignant tissue directly to improve survival and decrease systemic side effects. When IACis usedwith gemcitabine (GEM) or FLEC (5-fluorouracil, leucovorin, epirubicin, and carboplatin), the response rate for advanced pancreatic canceris significantly improved. This literature review introduces the use of hepatic intra-arterial chemotherapy in patients with metastatic pancreatic adenocarcinoma.

Intra-arterial Chemotherapy in Patients With Metastatic Breast Cancer: A Scoping Review.

Breast cancer is a common malignancy in women, and the survival rate for this cancer is low once itmetastasized. Currently, chemotherapy is the first-line treatment for metastatic breast cancer (MBC). However, when liver metastases (LM) are present, the response to chemotherapy is poor. Regional intra-arterial chemotherapy (RIAC) delivers a high concentration of anticancer drugs to the malignant tissue, which improves the survival rate of patients with LM. It also decreases systemic side effects associated with chemotherapy. RIAC leads to higher remission rates becauseitdirectly targets the affected area. When RIAC is used alongside systemic chemotherapy, tumor resistance is decreased, increasing the rates of remission. This review aims to introduce the use of RIAC in patients with MBC. RIAC is a relatively new therapy in interventional oncology, and thus, limited research is currently available.

Dynamics of level of the tumor-associated marker SCCA in neoadjuvant superselective intra-arterial chemotherapy in patients with cervical squamous cell carcinoma

Background. Evaluation of a tumor-associated marker SCCA (squamous cell carcinoma antigen) level is used in cervical squamous cell carcinoma (CC) to predict the course of the tumor process, monitor the effectiveness of chemo- and chemoradiotherapy, and for preclinical detection of recurrence in follow-up of patients after the completion of primary treatment. However, publications devoted to the study of the possibility of using SCCA level as an additional criterion for the effectiveness of neoadjuvant intra-arterial chemotherapy (IACT) are still rare.Aim. Study of the tumor marker SCCA level in patients with locally advanced squamous CC during neoadjuvant IACT as an additional factor in assessing its effectiveness.Materials and methods. 53 patients with locally advanced squamous CC IB—IVB stages (T1b-3bN0-1M0-1) were included to the study. The mean age of patients was 45.6 years (25-64 years). All patients underwent superselective neoadjuvant IACT with cisplatine (in combination with intravenous administration of docetaxel or paclitaxel). Serum SCCA levels in CC patients were assessed before the first and after the second course of neoadjuvant IACT compared to the clinical effect of treatment after two courses (RECIST 1.1 criteria).Results. SCCA level after 2 courses decreased in all patients with initially increased its level, while the proportion of SCCA-positive cases decreased from 71.7 to 26.4 %. When baseline SCCA values were normal, a complete response was achieved more often than with initially elevated levels (26.7 % vs 15.8 %), while distribution by tumor stages was similar in both subgroups. It has been established that if, after 2 courses of neoadjuvant IACT, SCCA levels exceeds 2.1 ng/ml and/or (for patients with initially increased SCCA value) it decreased by less than 60 % from the baseline, probability to achieve complete response after realization of effect of 2 courses of IACT was extremely small. Strong correlation (R = 0.829) between initial level of SCCA and degree of its decrease after 2 courses of IACT was discovered in the group of patients with complete response after the second course of IACT. It was getting lower in partial response group (R = 0.778) and stabilization group (R = 0.750).Conclusion. Dynamics of SCCA level after 2 courses of IACT in squamous CC patients can be used as additional criterion of the degree of treatment effectiveness.

Efficacy and adverse reactions of intra-arterial chemotherapy in patients with bladder cancer: A systematic review and meta-analysis.

This meta-analysis investigated the efficacies of intra-arterial chemotherapy (IAC) plus intravesical chemotherapy (IVC) versus IVC alone in patients with non-muscle-invasive bladder cancer (NMIBC), and preoperative IAC versus preoperative intravenous chemotherapy (IV) in patients with bladder cancer. We also assessed the adverse reactions (ARs) of IAC. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for English articles published before April 2021. The qualities of cohort studies and randomized controlled trials were analyzed using the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool, respectively. Effect outcomes were computed by random-effects and fixed-effects models. Statistical analyses were conducted using Stata 16.0 and RevMan v5.3.0. A total of seven articles were included. The analysis revealed that IAC plus IVC significantly prolonged recurrence-free survival (RFS) (hazard ratio [HR] = 0.55, 95% confidence interval [CI] = 0.40-0.76, I2 = 0%) and progression-free survival (PFS) (HR = 0.59, 95% CI = 0.37-0.97, I2 = 0%) compared with IVC alone in NMIBC patients after transurethral resection of bladder tumor (TURBT), but had no effect on overall survival (OS), tumor recurrence interval, or tumor-specific death rate. Preoperative IAC had no significant OS benefit compared with preoperative IV in bladder cancer patients. Regarding ARs, patients treated with IAC were significantly more likely to develop grade 1-2 ARs, including nausea/vomiting (odds ratio [OR] = 26.38, 95% CI = 1.88-370.79, I2 = 78%), neutropenia (OR = 10.15, 95% CI = 3.01-34.24, I2 = 0%), hypoleukemia (OR = 5.49, 95% CI = 1.38-21.82, I2 = 26%), and increased alanine aminotransferase (OR = 12.28, 95% CI = 2.24-67.43, I2 = 0%), but there was no significant difference between grade 1-2 ARs and grade 3-4 ARs in terms of increased creatinine in patients treated with IAC. Therefore, administration of IAC plus IVC after TURBT improved RFS and PFS compared with IAC alone in patients with NMIBC. IAC was associated with mild ARs and was well tolerated by most patients.

First experience of using combination of conformal radiation therapy with intraarterial administration of gemcitabine and nanostabilized paclitaxel in patients with locally advanced pancreatic cancer complicated by persistent chronic pain

Introduction. Locally advanced pancreatic cancer (LAPC) is accompanied by a diverse clinical picture, one of the leading symptoms is chronic pain syndrome (CPS), which occurs in 30 % of patients in the early stages of the disease and in 80 % of patients with advanced pancreatic cancer. The basic method of treating CPS is analgesic therapy. However, the widespread use of painkillers is limited due to the short and incomplete analgesic effects, as well as side effects of painkillers. The use of chemoradiotherapy (CRT) contributes to the relief of CPS, however, it is accompanied by adverse events (AE) and a short analgesic effect. Aim. The aim of the study was to evaluate the first experience of using of intra-arterial administration of a combination of gemcitabine at a dose of 1,000 mg/m2 and nano-stabilized paclitaxel at a dose of 125 mg/m 2 in combination with conformal radiation therapy in patients with LAPC with CPS. Materials and methods . A controlled open, single-center, non-randomized, retrospective study included 17 patients who received combined treatment - a single selective intra-arterial administration of gemcitabine at a dose of 1,000 mg/m 2 and nano-stabilized paclitaxel at a dose of 125 mg/m 2 , followed by conformal radiation therapy with beam of 51 Gr in medium fractionation mode. The dynamics of CPS was assessed by the intensity, severity, localization and characteristics of the applied analgesic therapy using the BPi-SF-Russian-2001 questionnaire when the patient was admitted before treatment, on the 24th and 54th days of combination therapy. Results. Complications associated with angiography and radiation therapy have not been reported. There were no pronounced (more than Grade 1) immediate and distant AEs of intra-arterial chemotherapy in patients. An analysis of CPS and its associated indicators showed a decrease in the severity of pain, which ultimately was an important component of the quality of life of patients. Significant decrease in CPS occurred on the 24th day before treatment. The analgesic effect was reliably maintained on the 54th day. The maximum analgesic effect of the combined treatment was noted on the 24th day. Thus, the duration of anesthesia was recorded up to 54 days. The analgesic effect significantly contributed to improving mood, the ability to contact with others, and also affected the quality and duration of sleep and the ability to enjoy life in patients of the study group. Conclusion. The use of intra-arterial chemotherapy with gemcitabine and nano-stabilized paclitaxel in combination with radiation therapy can effectively affect on CPS and the quality of life in patients with LAPC.

Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions.

Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing ≤10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing ≤10 kg with intraocular retinoblastoma. A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy. The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; P = .49). Cumulative radiation exposure per eye was significantly lower in infants weighing ≤10 kg (5.0 Gym2 versus 7.7 Gym2; P = .01). Patients weighing ≤10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; P = .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; P = .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; P = .01). Patients weighing ≤10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; P = .01). On multivariate analysis, weight ≤10 kg was not an independent predictor of complications or procedure failure. Intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.

Abstract WP20: Intra-Arterial Chemotherapy for Retinoblastoma in Infants<10 kg: 74 Treated Eyes With 222 IAC Sessions

Background: Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has dramatically altered the natural history of the disease. The spectacular outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients < 10 kg of weight. Objective: We aim to share our findings and experience in a large series of IAC infusions performed in infants < 10 kg. Methods: A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with IAC as either primary or secondary treatment. Results: There were 207 Rb tumors of 207 eyes in 197 consecutive patients. Of these, patient weight was 10 kg in 69 (35.7%) and >10 kg in 133 (67.5%) patients. Of the 69 patients weighing < 10 kg, 5 patients had bilateral Rb. Thus, a total of 74 eyes of 69 patients weighing < 10 kg were compared to 133 eyes of 133 patients weighing > 10 kg. Comparison ( < 10 kg vs. >10 kg) revealed the total number of IAC cycles was 222 vs. 436. Periprocedural complications occurred in 2 (0.9%) vs. 2 (0.45%) infusions ( p =0.49). Aborted procedure occurred in 12 (5.4%) vs. 7 (1.6%) infusions ( p =0.005). Enucleation following IAC was required in 14 (18.9) vs. 44 (33%) eyes ( p =0.029). On multivariate analysis, weight < 10 kg was not an independent predictor of complications, procedure failure, or eye enucleation. Conclusions: Our results speak for the safety and efficacy of IAC in patients < 10 kg.

Intra-arterial chemotherapy for advanced pancreatic cancer

Objective. To study effectiveness of intra-arterial chemotherapy in patients with locally advanced and metastatic pancreatic cancer.Material and methods. There were 329 patients who underwent regional chemotherapy in 2000 – 2015 (infusion through celiac trunk – 167, chemoembolization of gastroduodenal artery – 52, combination of these methods – 72, combined chemo-radiotherapy – 38). Locally advanced unresectable pancreatic cancer with arterial invasion (T4 grade) was observed in 198 (60.2%) patients, liver metastases (stage IV) – in 131 (39.8%) patients. Chemoembolization or chemoradiation therapy was performed for patients without distant metastases.Results. The best results for unresectable pancreatic cancer were obtained in 160 patients after chemoembolization combined with infusion. Partial response was obtained in 24.1% of cases compared with 8.9% and 13.4% of cases after infusion or chemoembolization alone. Mean life expectancy was 15.5 months compared with 14.6 and 10.6 months, respectively. Median of life expectancy was 15.6 months compared with 11.7 and 10.8 months, respectively. At the same time, progression of disease was observed in the majority of 131 patients with metastatic cancer. Partial response was noted only in 2.3% of patients only after chemoinfusion. Survival and median survival after chemoinfusion and combination of chemoembolization with chemoinfusion were similar (10.1 (8.3) and 10.9 (7.5) months). Chemoradiotherapy in 4 patients with initially unresectable pancreatic cancer resulted reduction of tumor dimension by 28% (24–32%). Therefore, radical operations were performed later. One-year survival was achieved in 20 (58.8%) out of 34 patients with unresectable pancreatic cancer. Mean life expectancy was 15.4 months (median 13.8 months).Conclusion. Intra-arterial chemotherapy is effective treatment in patients with pancreatic cancer stage III and IV. Combination of celiac axis infusion with arterial embolization, as well as infusion with radiotherapy resulted the best survival. Certain advantage of chemoinfusion was found for liver metastases. The use of new chemotherapy modes for intra-arterial infusion requires further study.

Long-term result of out-patient intra-arterial chemotherapy in patients with stage II and III oral cancer.

e17569 Background: We have developed a superselective intra-arterial chemotherapy (iaCT) approach for oral cancer, in which intra-arterial catheter is retrogradely inserted via the superficial temporal artery and/or occipital artery. The extra-arterial portion of catheter is connected to an infusion reservoir implanted subcutaneously around the mastoid process through the subcutaneous tunnel. The catheter and reservoir are completely placed under the skin, so there is little possibility of catheter-related issues such as infection and displacement. Hence, out-patient iaCT (op-iaCT) can be performed. This method has improved ADL of patients without any loss of curative effect and oral function. We reported the usefulness of op-iaCT at the ASCO annual meeting in 2013. We assessed the long-term outcome and survival rate of patients with stage II and III oral cancer who received op-iaCT and survived for at least 5 years. Methods: We have used op-iaCT for 46 patients who had oral cancer, out of which we selected 14 patients with stage II and III oral cancer, and monitored them for more than 5 years. Results: Two patients died owing to distant metastasis, to the brain and liver, and 12 patients were cancer-free. Neck metastases were detected after primary treatment and op-iaCT in 3 patients, who were salvaged by neck dissection. The 5-year survival rate was 86%. Conclusions: Distant and/or regional lymph node metastases were observed in 5 out of 14 patients. The op-iaCT improves quality of life of patients with stage II and III oral cancer, but the metastasis rate is somewhat high. Close observation, intravenous chemotherapy, and /or prophylactic neck dissection should be employed in the op-iaCT approach for oral cancer.

INTRA-ATERIAL CHEMOTHERAPY OF THE BREAST CANCER

Introduction. Breast cancer is now the most common malignant tumor among women with annually increasing incidence. One of the new, advanced and minimally invasive breast cancer treatment directions is intra-arterial neoadjuvant chemotherapy. The main purpose of the project is to analyze the results of intraarterial chemotherapy in 30 patients with breast cancer during the period 2004-2006. Materials and methods. Intraarterial chemotherapy was carried out by selective internal thoracic artery catheterisation (a. Thoracica interna), supplying blood for the area of tumor lesions of the breast. Chemotherapy used the common scheme - Taxotere 75 mg/m2 + Doxorubicin 60 mg/m2, doses of chemotherapy are calculated on the basis of the nomogram in dosages for intravenous infusion, the speed of infusion was 8001000 ml/h. The sequential intraarterial injection of chemotherapeutic agents took 3-4 hours. Preoperative chemotherapy consisted of 4 courses. The interval between courses was 3 weeks. Results. As a result of treatment after 2-year chemotherapy a partial regression process is registered in 19 (63.3%) patients, 11 (36.7%) patients got stabilized. After 4 treatments a complete regression is registered in 15 (50%) patients, partial regression - in 12 (40%) patients, stabilization of the process - in 3 (10%) patients. As a result of the above kind of treatment, 27 (90%) patients have managed to undergo radical mastectomy. Conclusion. Application of intraarterial chemotherapy in patients during advanced IIIa, IIIb stages of cancer allows to achieve partial regression even after 2-year therapy. However, despite the effectiveness of the method the intra-arterial chemotherapy is only a step before radiotherapy or surgical treatment, so the method should be used as an initial, important link in the combined treatment of breast cancer.

Method of intra-arterial chemotherapy of esophageal cancer

Esophagus it is an organ that takes blood from the different sources. Anatomic features of nourishment of esophageal tumors did not allow study them with the help of angiography like the tumors of other organs. In this connection intra-arterial way of chemotherapy drug administration for treating esophageal tumors is practically not studied.Methodology. For creating the maximal concentration of chemotherapy drug in esophageal tumor in the scientific department of the thorax tumors was elaborated the methodology of intra-arterial chemotherapy of esophageal cancer. Patients with cancer of the upper third of esophagus underwent catheterization of the clypeate cervical trunk or lower clypeate artery, middle third – left lower diaphragmatic artery, lower third – left gastric artery. Catheterization of the own esophageal arteries was not realized in any case.Results. At randomized research 34 patients underwent catheterization of esophageal arteries. Locally spread esophageal tumors have the dominant source of the blood supply and several secondary branches. The tumors growth results in hypertrophy of afferent preexisting vessels and development of neovascularization in the injury nidus. Conclusion. The use of intra-arterial chemotherapy in patients with esophageal cancer combined with the radiotherapy can be the method of choice for non-adjunctive and conservative treatment

DDEL-02INTRA-ARTERIAL CHEMOTHERAPY FOR RECURRENT PILOCYTIC ASTROCYTOMA

BACKGROUND: Pilocytic astrocytoma (PA) in general is a well differentiated low grade glioma. However, some are more aggressive and progress after initial resection and require repeat resection, radiation and/or chemotherapy. At recurrence overall survival in those who received prior radiation for a pilocytic astrocytoma precursor is shorter. In addition there is the concern for long term neuro-cognitive impairment as a result of brain radiation. We report the responses to carboplatin based intra-arterial (IA) chemotherapy for recurrent or progressive PA. METHODS: This retrospective review was IRB approved. 150 patients with histology confirmed pilocytic astrocytoma were diagnosed between 1997 and 2014. Twenty two had recurrences. Patient characteristics, treatment at progression, best responses, time to progression and duration of response overall survival differences between patients that received carboplatin based IA chemotherapy vs those that received alternate therapies were analyzed. Images were reviewed and response assessment was confirmed by a neuro-radiologist. RESULTS: Eleven patients received intra-arterial chemotherapy [6 were 18 years]. The remaining 11 received alternate therapies for recurrent PA. All had radiographically confirmed evidence of recurrent or progressive disease at the time of start of therapy IA therapy (8 supra-tentorial and 3 Infra-tentorial recurrences).6/11 patients that received IA therapy had failed prior therapies prior to starting IA chemotherapy, including one patient who progressed after intravenous carboplatin based therapy. Five patients were treated at first progression. One had radiation prior to IA therapy. 1 complete response, 3 partial responses and 7 stable diseases were noted in the IA group. 7/11(64%) had durable responses for over 2 years. CONCLUSION: Durable responses are possible with Carboplatin based IA chemotherapy in patients with recurrent PA even when they have failed IV therapy with similar regimens. IA chemotherapy may help delay radiation.

Neoadjuvant intra-arterial chemotherapy in patients with primary lacrimal adenoid cystic carcinoma.

BackgroundWe describe four cases of primary lacrimal adenoid cystic carcinoma (ACC) treated with neoadjuvant intra-arterial chemotherapy (NAIC).MethodsThe outcomes and complications of NAIC were reviewed. Several treatment-related local and/or systemic complications were noted.ResultsOne patient experienced ipsilateral eyelid and eyeball necrosis and permanent facial palsy; the second patient developed ipsilateral facial swelling and jaw claudication; and the third patient had febrile neutropenia, cellulitis, and phlebitis. These three patients underwent total exenteration. The fourth patient experienced neutropenia and thrombocytopenia and underwent tumour removal without exenteration. All patients were followed for more than 4 years and were alive at the last follow-up.ConclusionNeoadjuvant intra-arterial chemotherapy may be an alternative treatment that will improve the survival rate of ACC. However, careful and close observation is needed to minimise the risk of side effects. Further investigations are needed to justify the use of chemotherapy-related treatments and the associated costs.

Indications for intraarterial chemotherapy in patients with advanced retinoblastoma

AbstractPurpose Despite the use of new methods of treatment for retinoblastoma their efficacy remains debatable and depends on different factors. Our aim was to determine the indications and efficacy of intraarterial chemotherapy in patients with different growth pattern in advanced retinoblastoma.Methods For the period of last year 20 children (26 eyes) were treated for advanced and resistant retinoblastoma . 12 had monocular and 8 binocular RB. Age from 12 months to 6 years. 16 out of 20 children have had systemic chemotherapy. 13 patients have had exophytic growth and 7 – endophytic. All patients were treated with intraarterial chemotherapy with melfolan 7.5 mg (1‐3 injections).Results We were able to preserve 21 eyes out of 26 eyes. The retrospective analysis has showed that the enucleated eyes had endophytic growth with massive seeding of tumour into the vitreous body. The best effect after chemotherapy has been observed in untreated patients with exophytic growth and juxtopapillary localization.Conclusion Our experience shows that intraarterial chemotherapy in patients with endophytic growth of retinoblastoma has very low efficacy. The choice of method of treatment depends on tumour growth pattern, localization and duration of earlier done systemic chemotherapy.

Su2043 Serum VEGF Level and the Response to Combined Intra-Arterial Chemotherapy in Patients With Advanced Hepatocellular Carcinoma

A S L D A b st ra ct s 40.1±19.9kPa, p=0.01) and patients with nodules in the right liver lobe compared to the left lobe (46±20.4kPa vs 27.3±10.8kPa, p 15), patients with nodules >50mm had a significantly higher LSM value (71.8 ±4.8kPa vs 42.2±16.1kPa, p=0.001). Conclusion: There is a good correlation between liver stiffness assessed by Fibroscan® and HCC nodule size, in cirrhotic patients. Our data suggests that higher LSM values are registered in the presence of nodules >50mm in patients with low MELD score (< 15). Aggressive screening for HCC in cirrhotic patients with low MELD score and high LSM is mandatory, in order to early detect patients within Milan criteria for liver transplantation.

Hepatic intra-arterial chemotherapy in patients with advanced hepatocellular and biliary tract carcinomas using a temporary percutaneous catheter.

e14622 Background: Hepatocellular and biliary tract carcinomas are chemoresistant and poor prognosis malignancies. After around 30 years of no drug approval, sorafenib was registered as a first line in patients with advanced hepatocellular carcinoma (HCC) with preserved liver function. In HCC systemic chemotherapy did not improve survival, while very recent evidence suggested a possible efficacy of gemcitabine/cisplatin in biliary tract carcinomas (BTC). Nevertheless several studies supported a higher activity when chemotherapy is performed ashepatic intra-arterial infusion. This study evaluated feasibility, activity and toxicity of hepatic intra-arterial chemotherapy (HIAC) in patients with advanced HCC and BTC. Methods: Between July 1997 and June 2003, 43 consecutive patients with advanced unresectable tumor (28 HCC and 14 BTC) were enrolled. A 3-day HIAC, with 5-fluorouracil 1,000 mg/m2/day over 3 days as a continuous infusion, cisplatin 10 mg/m2 twice daily and mitomycin-C 2 mg/m2 twice daily on days 1-3, every 6 weeks until tumor progression or unacceptable toxicity, was performed through a radiologically placed temporary percutaneous catheter. Results: Ninety-nine cycles were delivered (median per patient: 2, range: 1-4). A partial response was observed in 4/14 BTC (28%), and 7/28 HCC (25%). Seven out of 14 (50%) BTC and 10/28 (36%) HCC had a stable disease (SD). Twenty HCC patients (46%) had a chronic liver disease. Twenty-seven patients (63%) were pre-treated. Manageable catheter-related complications were observed in 10 patients (23%). Most relevant grade 3-4 toxicities included neutropenia (2%), thrombocytopenia (5%) and transaminitis (12%). Febrile neutropenia was observed in one patient. No toxic deaths were observed. Conclusions: This study showed that HIAC with 5-fluorouracil, cisplatin and mitomycin-C, administered through a radiological temporary percutaneous catheter, represents a feasible, active, and well tolerated therapy in patients with advanced HCC and BTC. This treatment could be studied in selected patients with advanced HCC progressive on or not eligible for sorafenib and in patients with liver-dominant metastatic BTC. No significant financial relationships to disclose.

Influence of the etiology of liver cirrhosis on the response to combined intra-arterial chemotherapy in patients with advanced hepatocellular carcinoma

We have previously reported that intra-arterial chemotherapy prolongs the survival of patients with advanced HCC (aHCC); however, whether the response to intra-arterial chemotherapy depends on the etiology of underlying liver cirrhosis (LC) is still unknown. The aim of this study was to assess any influences of the etiology of LC on the response to combined intra-arterial chemotherapy for aHCC. A total of 53 adult Japanese LC patients (46 men and 7 women) with aHCC were treated with combined intra-arterial chemotherapy between 2002 and 2007 at our hospital. All of the patients had a Japan Integrated Staging (JIS) score of 3 or 4. Their tumors were inoperable according to computed tomography findings. Combined intra-arterial chemotherapy was administered via the proper hepatic artery every 5 days for 4 weeks and the chemotherapy regimen was continued for as long as possible. There were 15 patients with HBV infection (B-LC group), 29 patients with HCV infection (C-LC group), and nine patients with alcoholic cirrhosis (A-LC group). The percentage of patients with a complete or partial response after 4 weeks of chemotherapy was 0% in the B-LC group versus 31.0% in the C-LC group and 44.4% in the A-LC group. The survival of the A-LC and C-LC groups was significantly longer than that of the B-LC group with the median survival time being 688, 368, and 211 days, respectively. Combined intra-arterial chemotherapy might be more effective for aHCC in patients with A-LC or C-LC than in patients with B-LC.

The efficacy of hybrid chemotherapy with intravenous oxaliplatin and folinic acid and intra-hepatic infusion of 5-fluorouracil in patients with colorectal liver metastases: a phase II study

Intra-arterial chemotherapy in patients with liver metastases from colorectal cancer has some limitations such as hepatic toxicity and extra-hepatic progression. With the aim of overcoming these limitations, a phase II trial was designed to assess the efficacy and tolerability of a hybrid chemotherapy regimen with systemic infusion of oxaliplatin and folinic acid associated with intra-arterial 5-fluorouracil. Thirty-nine patients with colorectal liver metastases were recruited. The median age was 59 years, 30 patients (77%) had synchronous metastases, and half of the patients were chemo-naive. A total of 313 chemotherapy cycles were administered (median number 8). Treatment was well tolerated and hepatic toxicity negligible. Out of 34 evaluable patients an ORR of 41%. was observed. Eight patients (21%) underwent radical liver surgery. The median time to progression (TTP) was 10 months (range 2-63) and the median overall survival (OS) 21 months (range 6-63). Extra-hepatic progression was observed in six patients. Our results suggest that this regimen is active even if technical complications are frequent. Our aim to reduce hepatic toxicity and extra-hepatic progression was reached.

Hepatic intra-arterial chemotherapy in patients with metastatic breast cancer

10581 Background: Hepatic intra-arterial chemotherapy has been reported to produce higher response rate than systemic in patients (pts) with metastatic colorectal cancer. In breast cancer the liver is involved in up to 60% of cases and often conditions the prognosis. Nevertheless, only rare hepatic arterial infusion studies were published. Therefore, based on our previous experience in hepatic metastatic colorectal malignancies, we evaluated efficacy and toxicity of hepatic intra-arterial chemotherapy in pts with metastatic breast cancer. Methods: A three-day continuous arterial infusion (CAI) of fluorouracil 1000 mg/m2 q 24 hrs, with cisplatin 10 mg/m2 twice daily, and mitomycin-c 1 mg/m2 twice daily, was performed through a percutaneous radiological temporary trans-subclavicular catheter. Pts with responsive disease received up to four cycles every six weeks. Pts still responding could carry on with cisplatin and fluorouracil, without mitomycin-c. Pts were hospitalized and the catheter was removed upon end of infusion. Results: From 9.2000 to 6.2005, 25 pts with progressive liver metastases from breast cancer were treated. Nine had more than 50% of liver involvement. Fifteen had also extra-hepatic metastases. All had received antracyclines and 22/25 taxanes. Pts had a median of five previous chemotherapy lines. Median time from diagnosis of liver metastases to first CAI was 33 months (range: 7–110). Sixty-four total courses were administered, with a median of 2 (range: 1–7) per pts. Epigastric pain was the main clinical toxicity (54%) and iatrogenic gastro-duodenal ulcer, the main complication (28%). No relevant catheter-related complications occurred. Fifteen partial responses (60%) and eight stable diseases (32%) were observed. Response duration was 5.4 months (range: 2 - 27), time to progression 5.1 months (range: 2.5–29+), and median overall survival 13 months (range: 3.5+–32+). Conclusions: Hepatic arterial infusion of chemotherapy in heavily pre-treated pts with metastatic breast cancer is feasible and effective. A specific evaluation of quality of life should be performed to verify a real clinical benefit. An earlier timing during course of liver disease, and a shift to radiological implanted arterial port (allowing out-patient treatment), will be investigated. No significant financial relationships to disclose.

Reliability of CT-based tumor volumetry after intraarterial chemotherapy in patients with small carcinoma of the oral cavity and the oropharynx

The aim of the study was to evaluate the feasibility and consistency of CT-based tumor volumetry in patients with early carcinoma of the oral cavity and the oropharynx before and after intraarterial (IA) chemotherapy, comparing these data with clinical remission rates. Included in the study were 61 patients (mean age 59.3 years; 47 men) with histologically proven small carcinoma of the oral cavity or the oropharynx (local tumor stages T1/2). Patients received IA chemotherapy with high-dose cisplatin as part of a multimodal therapeutic regimen and underwent both clinical and radiological examination before and 4 weeks after local chemotherapy. Clinical evaluation of tumor response was possible in all patients (61/61). Radiological assessment of tumor volume was feasible in 42 of 61 patients (69%), but failed in 19 (31%) due to the absence of deep tumoral spread, lack of contrast enhancement or severe dental artifacts. Patients in whom evaluation was possible according to volumetric and clinical criteria revealed comparable remission rates: overall response 54.8% versus 52.4%, stable disease 40.4% versus 47.6%, and tumor progression 4.8% versus 0.0%. Because volume calculation was not feasible in approximately one-third of the patients, it cannot be recommended as a reliable indicator for treatment response in patients with small carcinoma of the oral cavity.