Intra-arterial Infusion Chemotherapy Research Articles

Prolonged and continuous percutaneous intra-arterial hepatic infusion chemotherapy in advanced metastatic liver adenocarcinoma from colorectal primary

Sixty patients with advanced metastatic adenocarcinoma of the liver from a colorectal primary were treated by prolonged and continuous intra-arterial hepatic arterial infusion chemotherapy over a period of time from December 1969 through July 1976. A 10-day course of 5-FU was administered in the hospital, and patients were discharged receiving 5-FUDR by continuous arterial infusion through a chronometric infusion pump. Objective responses of 100% were obtained in 15% of patients, 50% response in 39% of patients, and 25% response in 21% of patients. The median survival from onset of treatment was 8.5 months, 6.9 months, and 7 months, respectively, for 100%, 50%, and 25% responders versus 3.6 months for nonresponders. Survivals from onset of treatment were generally less in those with no disease-free interval. No relationship of response to sex and age was found. Patients previously treated with 5-FU intravenously responded to intra-arterial chemotherapy; 13% had a 100% response, and 54% had a 50% response. No relationship of drug dose to response was observed. Drug toxicity was frequently systemic and mild to moderate. Numerous complications occurred due to the catheter, complete or partial thrombosis occurring in 18.6% and 20.8%, respectively, and 30% of patients had displacement of the catheter. The role of partial arterial occlusion in terms of response and survival may be significant. Future studies should involve comparison of direct surgical placement versus percutaneous placement of catheters.

Intermittent occlusion of the hepatic artery and infusion chemotherapy for carcinoma of the liver

Twenty-nine patients with hepatocellular or metastatic colon carcinoma were included in the present study. A system of staging the extent of disease was developed to provide a guideline for patient selection and evaluation of the results of therapy. Sixteen patients received intraarterial infusion chemotherapy only and thirteen were treated by a combination of intermittent occlusion of the hepatic artery and infusion chemotherapy. In this latter group intermittent occlusion of the hepatic artery was employed as an alternative to hepatic artery ligation. Patients in either group having disease confined to the liver experienced good response to treatment, had a low incidence of drug-related complications, and survived for relatively long periods. The study confirmed that intermittent occlusion of the hepatic artery is a safe procedure and that it is not accompanied by an increase in morbidity or mortality. The rationale for using this technic and the advantages it has over hepatic artery ligation were presented. The procedure is currently being utilized with increasing frequency in patients in relatively early stages of the disease. Accumulation of more material and longer periods of follow-up are required to determine the therapeutic advantages of the new method over infusion chemotherapy alone.

Combination Chemotherapy of Advanced Squamous Carcinoma of the Head and Neck

Combination chemotherapy in advanced squamous carcinoma of the head and neck resulted in objective remission in 5 of 8 patients, with a median duration of 9 months. In 4 patients, the intravenous chemotherapy was supplemented by regional intra-arterial short-time infusion chemotherapy, by which one patient obtained a partial remission and 3 a static disease. The most important results of the methods used were the subjective improvements of the patients. The side-effects were acceptable, and no serious complications were observed.

Intra-arterial infusion chemotherapy as preoperative treatment of locally advanced breast cancer.

Intra-arterial infusion chemotherapy was made through the internal mammary artery and subclavian artery in 12 cases of locally advanced breast cancer. Continuous infusion of 5-fluorouracil and intermittent injections of Mitomycin C were jointly made for 1 to 4 weeks in each artery. Marked response in not only the primary tumor but also lymph node metastasis was clinically observed, permitting extended radical mastectomy successfully in all cases. Remarkable regressive changes were histologically observed in cancer foci, especially in small ones, of resected specimens including axillary, parasternal, and supraclavicular lymph nodes. All cases except 1 have been healthy without any recurrence for 22 to 78 months after treatment. Intra-arterial infusion chemotherapy will this method is a useful preliminary procedure for surgical treatment of locally advanced breast cancer.

Intra-arterial infusion chemotherapy in head and neck cancer. A clinical and experimental study

Intra-arterial infusion chemotherapy in head and neck cancer. A clinical and experimental study

Aerosol chemotherapy of lung neoplasia.

THE administration of anticancer drugs in amounts necessary to obtain a therapeutic response can be associated with severe toxicity. Attempts to circumvent such toxicity have been made and examples of this include intra-arterial infusion chemotherapy and the administration of drugs directly into neoplastic lesions. We wish to suggest a novel extension of such regional cancer chemotherapy and to describe the use of aerosol dosing to confer protective antitumour effects in the lungs of mice carrying certain transplanted tumours.

Factors influencing the success of arterial infusion chemotherapy for cancer of the head and neck

Over a seven year period intra-arterial infusion chemotherapy was used for treatment of 113 patients with advanced cancer of the head and neck. The drugs employed were 5-fluorouracil, methotrexate, nitrogen mustard, and bleomycin. Infusion through the external carotid arteries and the use of low-flow infusion pumps were advantageous in avoiding serious neurologic morbidity. Regression of epidermoid, basal cell, and adenocystic carcinomas was observed. Partial or total responses were obtained in fifty-two cases, 46 per cent of the patients treated. Regression was usually brief, only 40 per cent lasting for more than two months and 7.7 per cent for more than twelve months. Response rates varied significantly with the primary site of the neoplasm. As a group, epidermoid carcinomas originating in the larynx, pharynx, parotid gland, skin and oral mucosa responded to treatment significantly more often and more often completely than did those of the tongue, lip, and maxillary antrum. Although response rates favored elderly patients, small tumors, unirradiated tumors, and tumors which recurred rapidly after excision, these tendencies failed to be confirmed statistically.

Growth inhibitors rapidly inactivated by the host as potential antineoplastic agents in intra-arterial infusion chemotherapy.

Certain compounds capable of blocking the growth of cultured animal cells or causing them to lose viability upon prolonged exposure may have no apparent effect upon tumor growth in vivo,</

Chemotherapy for Carcinoma of the Hypopharynx and Cervical Esophagus

Chemotherapy of hypopharyngeal and cervical esophageal cancer generally is considered to have minimal clinical significance, useful only as an adjuvant therapy.As to the methods of chemotherapy performed on actual clinical cases, there are intraarterial infusion combined with surgery and general adminstration for the purpose of prevention of distant metastasis. The intra-arterial infusion chemotherapy is hardly available for this disease, since it is difficult to infuse chemotherapeutics into the hypopharynx and cervical esophagus by retrograde catheterization through Truncus thyreocervicalis. On the other hand, general adminstration of anticancer agent is performed for the purpose of the prevention of distant metastasis, especially for the inhibition of pulmonary metastasis.As to the effect of Bleomycin in treatment of this disease, the rate of effectiveness is 42.8% in total 35 cases.The posibility of this disease being caused by means of Bleomycin alone was exceedingly small. But, the expectation was greater when the agent was adminstered in combination with irradiation treatment, in which the dosage of the either may be much smaller than when using them alone. The direct local injection of Bleomycin on recurrent foci is a curative therapy.

Combination cancer chemotherapy by regional intra-arterial or intra-aortic infusion of 5-fluorouracil and mitomycin-C with or without irradiation.

In conclusion the combination cancer chemotherapy with intra-arterial or intra-aortic infusion of 5-FU and MMC with or without irradiation has proved of great value in the treatment of unresectable or recurrent cancer and offered selected patients significant palliation (Table 1). In our studies of the patients with advanced head and neck cancer unsuitable for conventional surgery, 68% of the patients showed regression with intra-arterial infusion of 5-FU and MMC with or without irradiation. In 38 evaluable patients with primary and metastatic liver tumors and pancreatic cancer, 71% of the patients showed objective evidence of response following hepatic artery infusion of 5-FU and MMC. Survival with this treatment for approximately 6 months was achieved in 53% of the patients so treated and 20% survival rate was achieved at the 12 month point. Objective tumor response was noted in 53% of the patients with pulmonary and gastrointestinal tract cancer by regional intra-aortic subselective infusion of 5-FU and MMC with or without irradiation. Analysis showed that 40% of the evaluable patients with lung cancer, 57% of the patients with stomach cancer, and 47% of the patients with colorectal cancer respectively demonstrated positive response to this therapy. The patients with unresectable colorectal cancer showed 50% survival rate at 12 month point after start of treatment with an average survival of 12.9 months. In 67 of over all 109 evaluable patients (61%) so treated the results has been good in terms of objective tumor regression and they sustained transient clinical benefits. Forty two of the 109 evaluable patients were classified as unimproved. Forty-three patients were un-evaluable since either the patient failed to complete the therapeutic regimen according to the protocol or the primary tumor was resected before starting the infusion chemotherapy or the patient was recent case before evaluation. Our results suggest that far advanced, non-resectable local malignancies without demonstrable distant metastasis should be treated vigorously with combined intra-arterial or intra-aortic infusion chemotherapy of 5-FU and MMC and irradiation.

Methotrexate excretion patterns and renal toxicity after intravenous injection or arterial infusion.

The cancer chemotherapy group at the Lahey Clinic Foundation has been active in using regional intraarterial infusion chemotherapy of far-advanced solid tumors in various body regions. 1 Problems have been encountered during regional therapy with the folic acid antagonist, methotrexate. If methotrexate is administered regionally in patients with impaired renal function, systemic toxic reactions to the drug are seen at low levels of dosage, presumably because of impaired excretion of drug by the kidneys. In the individual with normal renal function, no methotrexate is detectable in the serum shortly after an intravenous dose. 2 When renal function is impaired, appreciable amounts of the drug are present in the serum, even after 48 hours. 3 The current experiments were carried out to study the dynamics of enhanced drug toxicity observed in association with impaired renal function. Experimental Procedure Female mongrel dogs weighing between 20 and 25 kg (44 and 55 1b)

Pre-operative angiography and regional intra-arterial infusion chemotherapy for cancer of alimentary organs by small laparotomy following peritoneoscope technic

Pre-operative angiography and regional intra-arterial infusion chemotherapy for cancer of alimentary organs by small laparotomy following peritoneoscope technic

Treatment of cavernous hemangioma of the tongue by continuous intra-arterial infusion of 5-fluorouracil

A thirty-seven year old white woman with an enlarging cavernous hemangioma of the tongue, which recurred after sclerosing therapy and surgery had been given, was treated with continuous intra-arterial infusion chemotherapy using the antimetabolite, 5-fluorouracil. The salutary results, consisting of reduction in size and vascularity of the lesion, have lasted a year and five months to the time of publication of this report, and suggest that this means of therapy may be useful in the management of certain enlarging and troublesome vascular malformations.

Infusion chemotherapy in head and neck tumors.

THE PATIENTS with advanced cancers of the head and neck remain a difficult palliative problem for the oncologist. Their systemic metastases develop relatively late in spite of the locally extensive disease and often the adjacent tissues will tolerate no additional radiation therapy; and the tumor distribution is such that neurosurgical procedures have little or nothing to offer for pain relief. This study evaluates the role of intraarterial infusion chemotherapy in such advanced head and neck cancer patients in terms of pain relief, tumor regression, and operability after infusion therapy. Materials and Methods Eleven patients with advanced head and neck tumors were given 15 courses of intra-arterial infusion chemotherapy. Their ages ranged from 18 to 81 years, their mean age being 49 years. Nine of the patients were male, two were female. Nine patients had squamous cell carcinomas of the head and neck region, one patient had a malignant melanoma of

ARTERIAL INFUSION CHEMOTHERAPY OF PRIMARY GLIOMAS.

A SERIES OF 30 patients with cerebral gliomas has received intra-arterial infusion chemotherapy at our institution over the past 3 years. This is a brief report summarizing our techniques and the negative results thus far obtained. Methods Each patient had the ipsilateral internal carotid artery cannulated percutaneously with a No. 18 polyethylene catheter. Radiographic identification of its location was obtained in each instance. The catheter was filled with a heparin solution when not in use and flushed several times a day. A simple electric rotary pump delivered 1 cc/min of the drug solution during the infusion. Eighteen patients received mechlorethamine hydrochloride (nitrogen mustard) at a dose of 2 to 4 mg/day until a total of 25 to 30 mg had been administered. Simultaneously, 250 mg of sodium thiosulfate per milligram of HN2was administered intravenously to neutralize the HN2and thereby protected the hemopoietic system.1 Twelve patients