Intra-arterial Infusion Chemotherapy Research Articles

Effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patients with advanced gastric cancer

To evaluate the effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patient with gastric cancer. Between January 2009 and January 2011, 139 patients with curable stage T2N2 or T3N2 gastric cancer were randomly assigned to group 1(69 cases, neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy before gastrectomy and D2 lymphadenectomy) and group 2(70 cases,gastrectomy and D2 lymphadenectomy alone). The morbidity of postoperative pneumonia in the two groups were recorded respectively. The two groups were similar with respect to various clinical or pathological characteristics. All the patients underwent gastrectomy and D2 lymphadenectomy successfully. Eight patients in group 1 suffered from the postoperative pneumonia, accounting for 11.6%. Nine patients in group 2 suffered from the postoperative pneumonia, accounting for 12.9%. There was no significant difference between the two groups about the incidence of postoperative pneumonia. Surgery following neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy is safe with similar morbidity of postoperative pneumonia to immediate surgery in patients with locally-advanced resectable gastric carcinoma.

Phase I study of sorafenib in combination with low-dose cisplatin and fluorouracil intra-arterial infusion chemotherapy.

e14563 Background: This study aimed to determine the recommended dose for combination therapy of sorafenib with hepatic arterial infusion of low dose cisplatin and fluorouracil in patients with adv...

Convenient selective intra-arterial continuous infusion chemotherapy via the superior thyroid artery for oral cancer

Objective We designed a convenient method of selective intra-arterial infusion chemotherapy to treat oral cancer with low-dose 5-fluorouracil. Patients and methods Twenty-seven primary cases treated with this method with concomitant external irradiation. The reasons for performing selective continuous intra-arterial infusion were severe systemic disease in four cases, advanced age in seven cases, unresectability in nine cases, preoperative chemotherapy in five cases, and two patients refused surgery. Results The overall treatment effects were as follows: complete response in 13 cases, partial response in 12 cases, and no change in two cases. None of the patients experienced disease progression while receiving concurrent chemoradiotherapy. Twenty-three toxic adverse events ranging from grades 1 to 4 developed in 25 patients. A grade 1 complication developed in six patients; oral and/or pharyngeal mucositis developed frequently in 12 patients. Hematologic adverse events such as leukocytopenia or thrombocytopenia were observed in five patients, but no grade 3 or 4 events developed in any patients. Conclusions These data indicated that our method is suitable for patients who cannot undergo surgery or systemic chemotherapy due to old age or severe systemic disease.

Enucleated eyes after failed intra-arterial infusion of chemotherapy for unilateral retinoblastoma: histopathologic evaluation of vitreous seeding

Selective intra-arterial chemotherapy (IAC) has been adopted by many ocular oncology centers to treat advanced intraocular retinoblastoma. In this report, we describe two patients with unilateral intraocular retinoblastoma and persistent vitreous seeding, who were treated with IAC after failed systemic chemotherapy. Despite multiple sessions and increasing dosage of drug delivery, vitreous seeding in these cases failed to respond to IAC, and ultimately both eyes were enucleated for tumor control. Based on the histopathologic findings in these two cases, IAC appears to have limitations in treating persistent vitreous seeding in eyes which have failed systemic chemotherapy. Possible causes for failure of IAC to treat persistent vitreous seeding include poor vitreous penetration, inactive state of tumor seeds within the avascular vitreous cavity, and chemotherapeutic drug resistance.

口腔癌の頸部リンパ節に対する超選択的動注化学放射線療法の効果

口腔癌の頸部リンパ節に対する超選択的動注化学放射線療法の効果

Combination therapy of intra-arterial 5-fluorouracil and systemic pegylated interferon α-2b for advanced hepatocellular carcinoma

This study evaluated the efficacy of combined 5-fluorouracil (5-FU) and pegylated interferon (PEG-IFN) α-2b in patients with advanced hepatocellular carcinoma (HCC). Fifty patients with portal vein tumor thrombosis were enrolled. Of these, 21 patients were treated using subcutaneous administration of PEG-IFNα-2b and intra-arterial infusion of 5-FU (5-FU/PEG-IFN group), 12 patients were treated using intramuscular administration of IFNα-2b and intra-arterial infusion of 5-FU (5-FU/IFN group), and 17 patients received intra-arterial infusion chemotherapy with lipiodol-cisplatin (CDDP) suspension (CDDP group). The objective early response rate was significantly higher in the 5-FU/PEG-IFN group than in the 5-FU/IFN or CDDP groups (71.4 vs. 8.3% and 17.6%, respectively; P < 0.0001). Cumulative survival rates at 6 and 12 months were 83.8 and 77.8% in the 5-FU/PEG-IFN group, 60.8 and 16.2% in the 5-FU/IFN group, and 58.4 and 12.5% in the CDDP group, respectively. The cumulative survival rate was significantly higher in the 5-FU/PEG-IFN group than in the other 2 groups (P = 0.0272). Serious complications and treatment-related deaths were not observed in any of the 3 groups. Although a prospective randomized controlled trial using a larger population of patients with advanced HCC is needed to evaluate combination therapy with 5-FU and PEG-IFNα-2b, this new combination therapy may be useful for patients with advanced HCC.

Continuous intra-arterial infusion chemotherapy as a palliative treatment for oral squamous cell carcinoma in octogenarian or older patients

We intend to determine the potential benefits and analyze the outcomes of regional intra-arterial infusion chemotherapy (IAIC) for the octogenarian and older patients with oral cancer. Eighteen patients with oral squamous cell carcinoma were included. They were 12 males and six females with ages ranging from 80 to 96 years. An implantable port-catheter system was used for catheterization. Using a portable pump, methotrexate was given continuously through the external carotid artery for a mean period of 5.5 days (range, 4-7 days) followed by weekly bolus of low dose (25mg) of methotrexate until the clinical condition was stabilized. During the first week of IAIC, all tumors began to reduce in size. Of them 11 (61%) had a complete clinical response and 7 (39%) achieved a partial clinical response, after a mean follow-up period of 26 months (range, 8-72 months). The one- and three-year survival rates were 87% and 56%, respectively. There were no catheter-related complications. The side effects were mild and tolerable. IAIC might be specially indicated for oral cancer elderly with co-morbidity since a radical surgery or extensive radiotherapy can be avoided, and offers an acceptable palliative treatment in such patients.

Use of tumor arterial perfusion assessment and RECIST for prediction of survival and residual disease in hepatocellular carcinoma following intra-arterial infusion chemotherapy.

4128 Background: Tumor responses of hepatocellular carcinoma (HCC) are usually classified by RECIST criteria. Residual tumor perfusion indicated by arterial phase contrast enhancement may provide additional information regarding tumor viability. We evaluated HCC responses using both RECIST and residual arterial phase contrast tumor perfusion for contributions toward prediction of survival after treatment in nontransplant patients and for likelihood of residual disease in explants. Methods: This is a retrospective analysis. Pre- and post-treatment tumor sizes and post- treatment contrast enhancement characteristics were determined by multiphase CT or MR at 0, 30, 70, and 180 seconds after contrast injection. Post-treatment scans were performed 6 weeks after last IA. Nonperfusion (NP) was defined by absence of enhancement in residual tumor. For pts not undergoing transplant survival hazard rates were estimated for multiple baseline and treatment variables using uni- and multivariate analysis. For transplanted pts, liver explants were examined for residual viable tumor. Results: 189 pts with nonmetastatic HCC were treated with intra-arterial cisplatin and mitomycin, 35 receiving salvage adriamycin and 24 percutaneous ablation. Transplant: 53 of 189 pts underwent liver transplantation. Of 27 patients achieving NP status, 12 (44.4%) had no residual disease vs. 2 of 23 patients (8.7%) with residual enhancement had no residual disease. Nontransplant: 136 patients have been followed without transplant. Multivariate analyses demonstrated predictive significance (p<0.001) for survival for RECIST response, NP status, number of treatments, and treatment toxicity. At 3 yrs, no patient with residual perfusion was alive vs. 10/55 (18.2%) patients achieving NP status. Conclusions: Response most strongly correlates with residual disease in explants and survival in nontransplanted patients considering both RECIST and perfusion status after treatment. Survival 1-year 3-year N % N % N 3-yr CR 16 11.8 14 93.8 6 84.4 PR- NP 27 19.9 13 78.3 3 40.1 PR-P 18 13.2 10 59.2 0 0 SD-NP 12 8.8 6 73.3 1 18.3 SD-P 44 32.2 11 30.6 0 0 PD 19 13.9 5 24.5 0 0 No significant financial relationships to disclose.

Chapter 4: Chemotherapy and radiotherapy

Chapter 4: Chemotherapy and radiotherapy

Superselective Ophthalmic Artery Chemotherapy as Primary Treatment for Retinoblastoma (Chemosurgery)

To report on our 3-year experience with the use of superselective ophthalmic artery infusion of chemotherapy as initial, primary treatment for intraocular retinoblastoma. Prospective, institutional review board-approved clinical trial. Twenty-eight eyes of 23 newly diagnosed retinoblastoma patients (Reese-Ellsworth [RE] group V, 25 eyes; RE IV, 1 eye; RE III, 1 eye; RE II, 1 eye), ages 3-88 months (mean, 22; median, 11) followed for 3-37 months (mean, 15; median, 14). Cannulation of 1 or both ophthalmic arteries in young children with retinoblastoma was performed via the femoral artery under general anesthesia on an outpatient basis and chemotherapy (melphalan [n = 12], melphalan plus topotecan [n = 7], melphalan plus topotecan and carboplatin [n = 3], or melphalan plus carboplatin [n = 1]) infused. Patient survival, eye survival, systemic toxicity, complete blood counts, ophthalmic examination, retinal photography, and electroretinograms. We treated 23 newly diagnosed retinoblastoma patients initially with 75 separate intra-arterial chemotherapy infusions (range, 1-6 treatments; mean, 3.2) over a 3-year period. All children survived. Only 1 of the 28 eyes came to enucleation (for progressive disease). No eye was enucleated for ocular complications of the procedure and the only adverse ophthalmic findings were occasional transient lid edema, forehead hyperemia, and loss of nasal lashes. Kaplan-Meier enucleation free was 100% at 12 months and 89% at 2 years (95% confidence interval, 43%-98%). There were no deaths, strokes, or transfusions of any blood products; no effect on red cell count; 9 cycles of grade 3 and 1 cycle of grade 4 neutropenia; and no hospitalizations, episodes of fever/neutropenia, or complications at the site of femoral artery puncture. The ophthalmic artery(s) of children can safely be repeatedly canulated in very young children and high concentrations (but low doses) of chemotherapy infused on an outpatient basis. When used as initial therapy superselective chemotherapy delivered through the ophthalmic artery prevented enucleation, primary radiation or the use of systemic chemotherapy in 27 of 28 eyes.

SUPRASELECTIVE INJECTION OF INTRAARTERIAL MELPHALAN AS THE PRIMARY TREATMENT FOR LATE PRESENTATION UNILATERAL MULTIFOCAL STAGE VB RETINOBLASTOMA

The purpose of this study was to report a case of a 7-year-old girl with unilateral, multifocal Reese Ellsworth Stage Vb retinoblastoma who was successfully treated using intraarterial chemotherapy infusion as the primary therapy. This is an interventional case report. A 7-year-old girl presented with advanced unilateral retinoblastoma. The patient received intraarterial melphalan infusion therapy as the primary treatment. Complete tumor resolution was seen at 1 month after intraarterial melphalan infusion. This case of advanced retinoblastoma in a 7-year-old girl was successfully treated with intraarterial melphalan infusion alone. Treatment resulted in complete resolution of the tumor 1 month after treatment. In comparison with systemic chemotherapy, intraarterial melphalan infusion therapy may be a less toxic and more effective primary treatment option in the future management of advanced retinoblastoma.

Subselective Intra-arterial Chemotherapy Infusion in the Treatment of Hepatocellular Carcinoma

Intra-arterial delivery of chemotherapy is a well-established dominant treatment for hepatocellular carcinoma (HCC). This approach takes advantage of differential blood supply to the cancer, which is arterial, and to the liver, which is predominantly portal. Randomized trials demonstrating survival benefit have used transarterial chemoembolization (TACE) with arrest of blood flow and arterial obstruction to increase efficiency of drug delivery. Treatment-associated morbidity is significant but usually justified by the patient benefit. A number of alternative embolic particles have been explored to address efficacy and toxicity deficiencies of the original technology. In this article we list those materials. We then develop evidence that sub-selective arterial infusion therapy without embolic agents provides equivalent efficacy with less treatment morbidity.

Abstract No. 222: Intra-arterial infusion chemotherapy combined with radiotherapy for oral cancer: Review of 93 patients

Abstract No. 222: Intra-arterial infusion chemotherapy combined with radiotherapy for oral cancer: Review of 93 patients

舌癌動注化学療法中に発症した一過性急性脳症の1例

舌癌動注化学療法中に発症した一過性急性脳症の1例

Three-Dimensional Intravenous Digital Subtraction Angiography Using Flat Panel Detector System in Vascular Mapping of the External Carotid Artery: A Comparison with 3-Dimensional Computed Tomography Angiography

Super-selective intra-arterial infusion chemotherapy for head and neck cancer via the superficial temporal artery is an established procedure. Three-dimensional computed tomography angiography (3D-CTA) has often been used to assess the arterial anatomy. However, 3D-CTA images are sometimes affected by severe metallic artifacts near the oral cavity region, due to the presence of metallic dental materials. This study has evaluated 3-dimensional intravenous digital subtraction angiography (3D-IV-DSA) using a flat panel detector (FPD) system in vascular mapping of the external carotid artery (ECA), in comparison with 3D-CTA. To clarify the vascular anatomy of ECA branches, 15 patients had undergone both 3D-IV-DSA and 3D-CTA. The angiographic images of the ECA were generated using a volume-rendering technique. The 15 patients were also divided into two groups according to the existence of adverse effects due to dental metallic artifacts on 3D-CTA.Images from 3D-IVDSA were statistically significantly superior to 3D-CTA (P < 0.05). In particular, when metallic artifacts affected 3DCTA images, 3D-IV-DSA was able to depict the ECA more clearly. These findings confirm the utility of 3D-IV-DSA, and the technique may be particularly suitable for patients with metallic dental materials. Keywords: 3D-IV-DSA, rotational angiography, 3D-CTA, metallic artifacts, intra-arterial infusion chemotherapy, head and, neck cancer

A phase II study of intra-arterial chemotherapy of 5-fluorouracil, cisplatin, and mitomycin C for advanced nonresectable gastric cancer

The best choice of chemotherapy regimen for patients with advanced gastric cancer (AGC) is still a matter of controversy and requires further investigation. This study was performed to evaluate the efficacy and safety of intra-arterial infusion chemotherapy of 5-fluorouracil 1000 mg/m, cisplatin 50 mg/m, and mitomycin C 10 mg/m (FCM) repeated every 6 weeks, as first-line treatment for AGC. Forty-seven (95.9%) of the 49 patients were assessable for response. Four cases of complete response and 28 cases of partial response were confirmed, giving an overall response rate of 65.3% [95% confidence interval (CI): 52.0-78.6%]. The median time to progression and overall survival for all patients was 8.3 months (95% CI: 6.8-9.8 months) and 14.5 months (95% CI: 12.0-17.0 months). The estimate of overall survival at 12 and 24 months was 55.1% (95% CI: 41.2-69.0%) and 18.4% (95% CI: 7.5-29.2%), respectively. Most patients experienced neutropenia during their course of therapy with 21.3% of patients (n = 10) for grade 3/4 neutropenia. Grade 3 stomatitis, lethargy, and palmar-plantar erythema were observed in two (4.3%), eight (17.0%), and one (2.1%) patients, respectively. Yet, no grade 4 nonhematological toxicity was observed. Intra-arterial infusion chemotherapy of 5-fluorouracil 1000 mg/m, cisplatin 50 mg/m, and mitomycin C 10 mg/m is a tolerated treatment modality with promising activity in patients with previously untreated AGC.

Clinical results and histological changes following preoperative interventional treatment of the aggressive subtype of endometrial cancer

Objective The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy.

Distribution and slow-release characters of gemcitabine-loaded bovine serum albumin nanospheres in SD rats

Objective To detect safety,slow-release characters and targeting effects of two kinds of gemcitabine(GEM)-loaded bovine serum albumin nanospheres(mean particle diameters were 110 and 406 nm respectively)through tissue distribution in SD rats.Methods Thirty male SD rates were divided into 3 groups:(1)GEM group(n = 10);(2)110 nm GEM nanospheres group(n = 10);(3)406 nm GEM nanospheres group(n = 10).Pure GEM was used as the model drug,and SD rats as experimental model animal.The concentrations of GEM in blood plasma and various organs of SD rats were dynamically detected by high performance liquid chromatography(HPLC).Results Blood plasma GEM-time curve in GEM group was higher than the other two groups(P ＜ 0.05).The concentrations of GEM in targeting organs,including pancreas(155.59 μg/g),liver(43.57 μg/g)and spleen(35.27 μg/g),were significantly higher in 406 nm nanospheres group than the other two groups 6 h after administration,but those of GEM in heart(116.26 μg/g),lung(8.32 μg/g),kidney(92.10 μg/g),and muscles(81.58 μg/g)were similar to the other 2 groups(P ＞0.05).Conclusion 406 nm GEM-loaded serum albumin nanospheres had excellent targeting effect,slow-release character and safety,and could be applied to the treatment of pancreatic cancer by regional intra-arterial infusion chemotherapy. Key words: Gemcitabine; Nanoparticle; Albumin; Pancreatic carcinoma

Intra-Arterial Infusion Chemotherapy Using Cisplatin With Radiotherapy for Stage III Squamous Cell Carcinoma of the Cervix

To examine the effectiveness of concomitant intra-arterial infusion chemotherapy (IAIC) using cisplatin (CDDP) with radiotherapy for Stage III squamous cell carcinoma of the cervix. We analyzed 29 cases of Stage III squamous cell carcinoma of the uterine cervix treated with radiotherapy and IAIC of CDDP from 1991 to 2006. External-beam therapy was given to the whole pelvis using four opposing parallel fields with an 18-MV linear accelerator unit. A central shield was used after 30-40 Gy with external whole-pelvic irradiation, and the total dose was 50 Gy. High-dose-rate brachytherapy was given with (192)Ir microSelectron. The dose at Point A was 6 Gy per fraction, 2 fractions per week, and the total number of fractions was either 3 or 4. Two or three courses of IAIC were given concomitantly with CDDP 120 mg or carboplatin 300 mg. We confirmed excellent medicine distribution directly by using computed tomographic angiography. The 5-year overall survival rate for Stage III patients was 62%, the cause-specific survival rate was 70%, and the local relapse-free survival rate was 89%. Local recurrence, distant metastasis, and occurrences of both were 7%, 38%, and 3%, respectively. The incidence of severe acute hematologic adverse reactions (Grade > or =3) was 27% for all patients; however, all recovered without interruption of radiotherapy. Severe nonhematologic effects (Grade > or =3) were 3%, including nausea and ileus. Only 1 patient's radiotherapy was interrupted for a period of 1 week because of ileus. Severe late complication rates (Grade > or =3) for the bladder, rectum, and intestine were 3%, 3%, and 10%, respectively. A combination of IAIC and systemic chemotherapy should be considered to improve the prognosis of patients with Stage III squamous cell carcinoma of the cervix.

Lingual Carcinoma Metastases Presenting as Spontaneous Pneumothorax

Spontaneous pneumothorax is a rare manifestation of primary lung cancer or metastasis. We report a 39-year-old man with well-differentiated squamous cell carcinoma of the tongue and cervical lymph node metastases. He developed lung metastases and spontaneous pneumothorax 22 months later after intra-arterial infusion chemotherapy. The patient was managed with partial lung resection under thoracotomy. The pneumothorax resolved completely after the operation. Histological examination demonstrated metastatic squamous cell carcinoma, which had led to a bronchopleural fistula with subsequent induction of pneumothorax. The patient recovered uneventfully and continued to receive adjuvant chemotherapy in the oncology surgery outpatient department. Unfortunately, the tumors of the tongue and cervical lymph nodes progressively enlarged despite treatment. Eventually, the patient died of respiratory failure 5 months later. In most of the previously reported cases, pulmonary metastases associated with spontaneous pneumothorax usually originate from osteogenic or soft-tissue sarcomas. Although rare, pulmonary metastasis should be considered in the etiology of spontaneous pneumothorax. Despite advanced disease, surgical treatment may be feasible.