Intra-arterial Infusion Of 5-fluorouracil Research Articles

Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus.

Despite surgical removal of tumors with portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients, early recurrence tends to occur, and overall survival (OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization (TACE); subcutaneous administration of interferon-alpha (IFN-α) and intra-arterial infusion of 5-fluorouracil (5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy (5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.

Multidisciplinary therapy consisting of minimally invasive resection, irradiation, and intra‐arterial infusion of 5‐fluorouracil for maxillary sinus carcinomas

Current goals for the treatment of maxillary sinus carcinoma include the preservation of vision, eating, communication, and appearance, as well as the achievement of a cure. Japanese patients (n = 121) with maxillary sinus carcinoma were analyzed retrospectively. All patients underwent multidisciplinary therapy including minimally invasive resection, 20 Gy irradiation, and intra-arterial infusion of 5-fluorouracil. The 5- and 10-year overall survival rates were 73% and 68%, respectively. In 97 patients with squamous cell carcinoma (SCC), the 5- and 10-year overall survival rates were 76% and 70%, respectively. All 29 patients with orbital invasion retained the orbital contents, and 21 of these patients demonstrated adequate visual acuity. There were 16 complications, including trismus (5 patients), double vision (5 patients), fistula formation (3 patients), and cataract (3 patients). A multidisciplinary therapy, consisting of minimally invasive resection, irradiation, and regional chemotherapy, can yield good patient prognosis and quality of life after treatment.

Therapeutic efficacy of combination therapy with intra‐arterial 5‐fluorouracil and systemic pegylated interferon α‐2b for advanced hepatocellular carcinoma with portal venous invasion

The prognosis of advanced hepatocellular carcinoma (HCC) remains poor, particularly among patients with portal vein tumor thrombosis (PVTT). This study evaluated the efficacy of combined 5-fluorouracil and pegylated interferon (PEG-IFN) α-2b in patients with advanced HCC. Subjects comprised 59 HCC patients with PVTT treated using subcutaneous administration of PEG-IFNα-2b (50-100 μg on day 1 of each week for 4 weeks) and intra-arterial infusion of 5-fluorouracil (250 mg/d for 5 hours on days 1-5 of each week for 4 weeks). One treatment cycle lasted 4 weeks. The current therapy was discontinued in patients with progressive disease (PD). For responses other than PD, treatment was repeated for ≥1 cycle. The primary efficacy endpoint was the objective early response rate. Secondary efficacy endpoints were progression-free survival (PFS) and overall survival. Objective early response rate was 73.0%. Cumulative PFS rates were 67.4% at 6 months, 30.2% at 12 months, 25.9% at 18 months, and 20.7% at 24 months. Median PFS was 9.7 months. Cumulative survival rates were 82.4% at 6 months, 73.6% at 12 months, 52.8% at 24 months, and 44.0% at 36 months. Median survival time was 29.9 months. All adverse reactions were controllable by temporary suspension of treatment. Serious complications and treatment-related deaths were not observed. Although a prospective randomized controlled trial using a larger population of patients with advanced HCC is needed to evaluate combination therapy with 5-fluorouracil and PEG-IFNα-2b, this new combination therapy may be useful for patients with advanced HCC.

Twenty-four hour intra-arterial infusion of 5-fluorouracil, cisplatin, and leucovorin is more effective than 6-hour infusion for advanced hepatocellular carcinoma

To evaluate the time dependence of intra-arterial 5-fluorouracil (5-FU) therapy for advanced hepatocellular carcinoma (aHCC). Thirty-seven adult Japanese patients who had aHCC and liver cirrhosis were treated with combined intra-arterial 5-FU, cisplatin (CDDP), and leucovorin (LV). The Japan Integrated Staging score (JIS score) of each patient was 3 or more. The patients were divided into two groups, after which the 15 patients in group S were treated with 6-h infusion chemotherapy (LV at 12 mg/h, CDDP at 10 mg/h, and 5-FU at 250 mg/m2 per 4 h) and the 22 patients in group L were treated with 24-h infusion chemotherapy (LV at 12 mg/h, CDDP at 10 mg/h, and 5-FU at 250 mg/ m2 per 22 h). Continuous infusion chemotherapy was performed via the proper hepatic artery every 5 d for 4 wk using an implanted drug reservoir. The percentages of patients with a partial response after 4 wk of chemotherapy were 6.7% in group S and 31.8% in group L. The survival of group L was significantly better than that of group S, with the median survival time being 496 d in group L and 226 d in group S (P < 0.05). Continuous 24-h intra-arterial infusion is more effective for aHCC and can markedly prolong survival time as compared to 6-h infusion.

Intra-arterial Infusion of 5-fluorouracil plus Gm-csf and Chemoembolization with Melphalan in the Treatment of Disseminated Colorectal Liver Metastases

Intra-arterial Infusion of 5-fluorouracil plus Gm-csf and Chemoembolization with Melphalan in the Treatment of Disseminated Colorectal Liver Metastases

Intra-arterial infusion of 5-fluorouracil plus granulocyte–macrophage colony-stimulating factor (GM-CSF) and chemoembolization with melphalan in the treatment of disseminated colorectal liver metastases

Aims: We compared two prospective trials of intra-arterial cytokine/chemotherapeutic infusion plus chemoembolization in the treatment of inoperable colorectal liver metastases. Materials and Methods: One hundred and three patients with disseminated inoperable colorectal liver metastases received intra-arterial chemotherapy with 5-FU and granulocyte–macrophage colony-stimulating factor (GM-CSF) plus chemoembolization via an angiographically positioned hepatic artery catheter. Two different regimens were used in two consecutive studies. Group A: short-term i.a. infusion of 550 mg/m25-FU (days 1–4) plus 80 μg/m2GM-CSF (day 1+2) combined with chemoembolization with 25 mg/m2melphalan plus Lipiodol and Gelfoam (day 5). Group B: continuous circadian intra-arterially administered 1400 mg/m25-FU infusion plus 60 mg/m2i.v. leucovorin and 80 μg/m2GM-CSF (day 1+2) combined with chemoembolization with 25 mg/m2melphalan plus Lipiodol and Gelfoam (day 3). Results: One hundred and three patients (62 male/41 female) with a median age of 59.9 and a median Karnofsky index of 88.5 were treated with 447 cycles of immuno-chemoembolization (group A 299, group B 148 cycles). Fifty-seven percent of these patients had received prior systemic chemotherapy. Side-effects were seen in all patients, mainly upper abdominal pain lasting 1–4 days and grade 1 or 2 vomiting. Systemic side-effects were mild and transient with a very low rate of leukopenia. Using World Health Organization response criteria, the following responses could be demonstrated: group A: CR 2.7%, PR 32.4%, MR 21.6%, SD 12.7%, NR 16.2%; group B: CR 1.0%, PR 42.4%, MR 24.2%, SD 18.2%, NR 12.1%. Time to progression was 7 as compared to 8 months. Median survival was 17 months in group A, whereas it has not been reached after 28 months (P=0.0095) in group B. There was no statistically significant difference between chemonaive patients and patients who had received prior systemic therapy. Conclusion: Immuno-chemoembolization combined with 2-day circadian administration of 5-FU is an effective tool in the treatment of disseminated colorectal liver metastases. This regimen is also effective as second-line treatment.

Summary Facial paralysis induced by intra-arterial infusion and radiotherapy ; report of two cases

Many complications accompanied with intra-arterial infusion and radiotherapy for head and neck cancer have been reported. Among them facial paralysis is ralatively rare. Researchers say, the incidence of it has been about 5-9 % and its prognosis is usually benign. Two cases of it with preceding damage of auricle are reported. Case 1: 84-year-old woman with maxillar carcinoma. Treatment was intra-arterial infusion of 5-Fluorouracil (5-FU) through the superficial temporal artery and radiotherapy. Total dose of them were 6, 000 mg and 50 Gy. Erosion of the auricle occured at first and then perichondritis, and soon facial paralysis followed. The paralysis was recovered completely after eight weeks, but auricle was necrotizing and f alled into decay. Case 2 : 71-year-old man with maxillar carcinoma. Method of therapy in this case was same as case 1, but the total dose of 5-FU and radiation differed from that, 6, 250 mg and 47.5 Gy was given. Inflammation of auricle appeared and facial paralysis occurred soon after the end of series of infusion and radiation. His auricle came to be well cured, but facial paralysis has not improved yet. It is concluded that facial paralysis and inflammation of auricle in such cases is considered to be caused by ischemic change of the external carotid artery area.

Kinetic modeling of in vivo—nuclear magnetic resonance spectroscopy data: 5–Fluorouracil in liver and liver tumors

Kinetic modeling has been applied to the time course of the nuclear magnetic resonance signal intensities of 5-fluorouracil and the sum of its catabolites, alpha-fluoro-beta-ureido propanoic acid and alpha-fluoro-beta-alanine, as monitored in liver tumors of seven patients with cancer after brief intraarterial infusion of 5-fluorouracil. Because these data represent only relative tissue concentrations, only ratios of clearance and volume parameters can be estimated (e.g., clearance/central volume of distribution or central volume of distribution/steady-state volume of distribution). On the other hand, parameters that do not refer to volumes, such as half-lives or maximal velocity of metabolic conversion of a nonlinear model, can be estimated in absolute terms. A nonlinear three-compartment model gave satisfactory fits with all of the individual data sets. Kinetics of 5-fluorouracil and catabolites were similar in five patients with metastases of colorectal adenocarcinomas but differed from those of two patients with cholangiocarcinoma and metastases of an anaplastic carcinoma of unknown origin, respectively.

A combined treatment of carcinoma of the maxillary sinus--treatment method for T4 cases

Between 1974 and 1986, 54 cases of squamous cell carcinoma of the maxillary sinus were treated combining surgery, radiotherapy and regional chemotherapy simultaneously. Using UICC (1987) system, these 54 cases were classified into one T1, four T2, thirty-three T3 and sixteen T4. The combined therapy consisted of 1) reduction operation followed by daily cleaning of the necrotic tumor mass; 2) external irradiation with less than 30Gy; 3) intra-arterial infusion of 5-fluorouracil (5-FU) and broxuridine (BUdR); and 4) final tumor resection under general anesthesia. As several modifications were made for the treatment procedure in 1979, the 54 cases were divided into two groups: Group A with 29 cases, which were treated before 1979 and Group B with 25 cases, which were treated after 1979. In this paper, the operative procedure, which we use for T4 cases is described. The first operation is performed after radiotherapy with about 10Gy and in this operation only the necrotic portion of the tumor mass is removed. The maxillary cavity is opened through the sublabial incision. This window is kept open and daily cleaning of the necrotic tumor mass is continued through the window. Three weeks after the simultaneous administration of radiation with 20Gy and 5 intra-arterial infusions of 5-FU and BUdR, the residual tumor is curetted thoroughly under general anesthesia. Surgery is performed through the sublabial window which has been kept open after the reduction surgery. Removal of the residual tumor mass which extends to the pterygomaxillary fossa, nasopharynx, anterior and medial skull base can be performed without difficulty, provided that the tumor mass is removed in pieces.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of the maxillary sinus with eosinophilia: Report of a case

A patient with carcinoma of the maxillary sinus presented with a blood eosinophilia and infiltration of eosinophilic leukocytes into the tumor tissue. Immediately after cancer therapy with intraarterial infusion of 5-fluorouracil into the superficial temporal artery, necrotomy and resection of the maxilla including radical neck dissection, the number of eosinophilic leukocytes was suddenly decreased and thereafter a transient increase in blood eosinophilic leukocyte count was observed. In this communication, a tentative mechanism for these events is suggested.

Heparinized catheters for long-term intraarterial infusion of 5-fluorouracil in liver metastases

A heparinized catheter was used for the regional infusion of 5-fluorouracil in seven patients with liver metastases. The hepatic artery was catheterized from the left brachial artery. The period of treatment varied from one to 13 weeks. Pull-out angiograms, obtained after eight catheterizations, revealed complete occlusion of the brachial artery in five and partial occlusion in three, although no patient had ischemic symptoms in the hand. Thus, heparinization of the catheter did not prevent thrombosis during long-term infusion therapy.

Triple drug intra-arterial infusion combined with x-ray therapy and surgery for head and neck cancer

Forty-four patients with advanced carcinoma of the head and neck in anatomic areas supplied by the external carotid artery have been treated by intra-arterial infusion of 5-fluorouracil (sodium), 4-amino-N 10-methylpteroylglutamic acid (methotrexate), and vinblastine (Velban). This was followed by radiation therapy and surgery when applicable. The patients in this excision are the potential cures. The patients who had response to therapy with 100 per cent regression of the tumor but did not undergo standard surgical extirpation because of inaccessibility of the lesion died of recurrent disease at the primary site within two years.

The continuous arterial infusion of 5-fluorouracil as a therapeutic adjunct in the treatment of advanced carcinoma of the bladder and prostate. A preliminary report.

Twenty-two patients have been treated with the intra-arterial infusion of 5-fluorouracil followed by megavoltage radiation. Nine patients with carcinoma of the prostate completed the protocol. All of these patients responded to 5-fluorouracil. This was documented by a decrease in tumor size, improvement in IVP and cystograms, lowering of specific acid phosphatase, control of bony metastasis, and a marked improvement in symptoms. Six of the patients are alive and asymptomatic today. Three patients have no clinical or microscopic evidence of retained disease. The mean survival is 21 months with a range of 13 to 31 months. Six of ten patients with bladder carcinoma responded to the 5-fluorouracil. This was documented by a marked reduction in tumor size in all patients and complete destruction of the tumor in four patients. Four of the patients are alive and microscopically free of their disease. The mean survival is 25 months with a range of 19 to 34 months. These results suggest that this therapeutic modality should be continued at our institution for advanced carcinomas of the bladder and prostate. In order that a more complete evaluation of the protocol be obtained, other institutions will have to participate in an identical treatment program.