Intra-arterial Infusion Therapy Research Articles

Randomized Comparison of Intra-Arterial Chemotherapy Versus Intra-Arterial Chemotherapy and Gelfoam Embolization for Treatment of Advanced Cervical Carcinoma

We evaluated the effects of intra-arterial infusion therapy by comparing the results obtained with a combination of intra-arterial anticancer drugs with and without transcatheter arterial embolization (TAE) in patients with cervical cancer. Between April 1999 and March 2003, intra-arterial therapy was administered to 45 patients (mean age 49 years) with cervical cancer. Of these, 18 had stage IIb , 4 had stage IIIa, 19 had stage IIIb, and 4 had stage IVb cancer; the histopathologic types were squamous cell carcinoma (n = 35), adenocarcinoma (n = 8), and adenosquamous carcinoma (n = 2). A total of 45 patients gave their informed consent and were randomized on a continuous basis into one of three groups according to the therapeutic protocols: group A consisted of 15 patients who received cisplatin, group B consisted of 17 patients who received cisplatin, mitomycin, doxorubicin hydrochloride, and 5-fluorouracil, and group C consisted of 13 patients who received cisplatin and TAE. Each protocol was administered twice with a 3 week interval between treatments. The efficacy of treatment was evaluated on the basis of the tumor reduction ratio (%) using MR imaging and the side effects were analyzed. In groups A, B, and C, the tumor reduction ratio was 54%, 84%, and 86%, respectively; it was significantly greater in groups B and C than in group A (p < 0.01). The difference between groups B and C was not statistically significant. Although all group C patients developed severe pain after TAE, the pain was controlled with analgesics. Thrombocytopenia occurred in 6 of 17 (35%) group B patients. Group B and C patients had better tumor reduction than those in group A. Fewer hematologic complications occurred in group C patients compared with group B.

Pilot study of combined intra-arterial infusion therapy with gemcitabine plus heptaplatin for unresectable hepatocellular carcinoma: Young Min Park, Sihyun Bae, Woochul Chung, Byunghun Byun, Jongyoung Choi, Sangbok Cha, Kyuwon Chung, Heesik Sun, Dooho Park, Byungkil Choi, Catholic University Medical College, Seoul South Korea

Pilot study of combined intra-arterial infusion therapy with gemcitabine plus heptaplatin for unresectable hepatocellular carcinoma: Young Min Park, Sihyun Bae, Woochul Chung, Byunghun Byun, Jongyoung Choi, Sangbok Cha, Kyuwon Chung, Heesik Sun, Dooho Park, Byungkil Choi, Catholic University Medical College, Seoul South Korea

Does Intra-arterial Infusion Therapy Ameliorate Pancreatic Perfusion?

Does Intra-arterial Infusion Therapy Ameliorate Pancreatic Perfusion?

Combination Therapy of Superselective Intra-arterial Nedaplatin Infusion and Radiation Therapy for Oral Cancer

Objective: Nedaplatin, which is a cisplatin-derivative, has been reported to be an effective anti-tumour agent for head and neck cancer. The purpose of this study was to address the feasibility of a combination of radiotherapy with superselective intra-arterial therapy using nedaplatin in patients with oral cancer.Patients and Methods: Fourteen patients with oral cancer were treated with chemotherapy by superselective intra-arterial infusion of nedaplatin (90 to 100 mg/m2) combined with concurrent radiation therapy (30 Gy). After evaluation, patients underwent surgery as a therapeutic procedure (resection of the primary tumour and/or the neck).Results: Complete and partial response rates were achieved by 8 patients (57.2%) and 6 patients (42.8%), respectively. Histological effects classified according to Oboshi-Shimosato's criteria were grade IV in 5 patients, grade IIb in 5, grade IIa in 3, and grade I in 1. Grade IV mucositis was observed in 3 patients (21.4%). All patients were free from renal dysfunction, which is one of the adverse effects of cisplatin. After a median follow-up of 24 months, the locoreginal control rate was 100%.Conclusion: The results indicate that a combination therapy of superselective intra-arterial nedaplatin infusion and radiation therapy can be delivered safely with good efficacy for locoregional management of oral cancer.

頭頚部癌に対する超選択的動注化学療法

We report the results of superselective intraarterial cisplatin (CDDP) infusion therapy combined with irradiation for 23 patients, mainly advanced head and neck carcinoma. All patients received intraarterial CDDP infusions with intravenous sodium thiosulfate (STS) neutralization. CDDP infusion was performed by the Seldinger's technique in 16 patients and by the implanted intraarterial reservoir system in 7 patients. STS was also infused by the reservoir system implanted at the forearm in most patients.An overall response was observed in 21 of the 23 (91.3%) patients. Complete and partial responses were achieved in 16 (69.6%) and 5 (21.7%) patients, respectively. There were no patients with worse than grade III complications. We concluded that superselective intraarterial infusion therapy with a high dose of CDDP and STS was very effective for the management of advanced head and neck carcinomas and we recommend the implantable reservoir system for both CDDP and STS administration as an easy and low-invasive method.

Intraarterial Infusion of Lipiodol CDDP Suspension into the Internal Iliac Artery-Pre Clinical Dose Escalation Study Using Canine Model-

Background and Aims : To investigate the usefulness of intraarterial chemotherapy (IAC) with CDDP powder and lipiodol suspension (LCS) for invasive bladder cancer as a dose escalation modality of conventional IAC, we administered LCS into the internal iliac artery of dogs and evaluated pharmacokinetics of CDDP. Methods : An angiographic catheter was inserted to the internal iliac artery of an anesthetized dog under fluoroscopic guidance. CDDP solution, LCS, or a combination of CDDP solution and LCS were intra-arterially infused. For comparison, CDDP solution was also intravenously infused. The dose of CDDP ranged from 1 to 3 mg/kg. For combination study, the dose of CDDP ranged from 3 to 5 mg/kg. In all groups, blood samples were collected 5, 15, 30, 60, 120, and 180 minutes after administration, and serum Pt levels were measured. Results : In the LCS group, the serum Pt level was lower than those after intravenous or intraarterial infusion of CDDP solution. In the combination therapy group, the serum Pt level increased with the total dose of CDDP. Conclusions : Intraarterial infusion of LCS showed a lower systemic CDDP level. This method may reduce the incidence of side effects, suggesting the usefulness of intraarterial infusion therapy with LCS for invasive bladder cancer.

超選択的動注と放射線の同時併用療法

Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment.Patients and methods: Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120mg/m2/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65Gy/26f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1).Results: During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, MRSA pneumonia, sepsis, tetraplasia, and osteoradionecrosis.Conclusions: We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed.

A combination therapy of continuous superselective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma

A combination therapy of continuous superselective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma

A combination therapy of continuous superselective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma

To improve the treatment result for locally advanced head and neck carcinoma, the authors used a combination of radiotherapy with superselective continuous intraarterial therapy using carboplatin. The dose limiting toxicity (DLT), maximum tolerated dose (MTD), and treatment effectiveness were tested in Phase I and II protocols. PATIENTS AND METHODS. Thirty-five patients were entered into the study from August 1992 to May 1997. The target arteries were the lingual artery in 18 cases, facial artery in 5 cases, maxillary artery in 11 cases, and external carotid artery initially changing to lingual artery in 1 case. Escalating daily carboplatin doses were tested, starting from 10 mg/m(2) (total dose, 360 or 400 mg/m(2)) to 15 mg/m(2) (total dose, 405 or 450 mg/m(2)) and then 20 mg/m(2) (total dose, 460 or 500 mg/m(2)). Radiotherapy was administered using a 6-megavolt linear accelerator to a total dose of 50-60 grays. Interstitial radiotherapy boost also was used for carcinoma of the tongue. Excluding 3 patients who discontinued treatment, the treatment results of 32 patients were complete response in 21 cases, partial response in 10 cases, and no change in 1 case. Neutropenia was the DLT, and the MTD was 500 mg/m(2). The local control rate was 64%. Superselective continuous intraarterial carboplatin and concurrent radiation therapy can be delivered safely with good efficacy for locally advanced carcinomas of the tongue and base of the tongue. Surgical treatment of these diseases usually incurs severe functional loss. This current approach may be a breakthrough in these cancers.

Continuous intra-arterial infusion therapy in hydrofluoric acid burns.

To determine the effect of continuous intra-arterial calcium gluconate infusion therapy on patients suffering from hydrofluoric acid dermal burns of the digits, clinical treatment was performed prospectively on 10 patients from January 1997 to December 1998 at the burn care unit of Kaohsiung Medical University Hospital. An arterial catheter was inserted transcutaneously through the radial artery of the involved hand. After confirmation of the proper position of the catheter, calcium gluconate was infused continuously with an ambulatory infusion pump. Rapid pain relief was achieved immediately after infusion. The rate of infusion was then tapered down gradually, and treatment was completed with no major therapeutic complication. All injured digits of these 10 patients were successfully salvaged with good cosmetic appearance and complete functional preservation. Compared with other conventional therapies, continuous intra-arterial calcium gluconate infusion therapy proved to be a safe, rapid, simple, portable, and effective method for treating hydrofluoric acid dermal burns.

Mesenteric vascular occlusion resulting in intestinal necrosis in children

Purpose: The records of 4 patients who had necrotic bowel secondary to acute mesenteric vascular occlusion affecting various levels of mesenteric vasculature were reviewed to determine the clinical manifestations, diagnostic investigations, predisposing factors, complications, and outcome of mesenteric vascular thrombosis in children. Methods: The medical records of the patients (3 boys, 1 girl) treated between 1981 and 1996, inclusive, for bowel infarction secondary to mesenteric vascular thrombosis, were reviewed with regard to signs and symptoms, laboratory tests, radiological investigations, surgical findings, histopathologic examinations, and outcome. Results: The ages of the patients ranged between 1 and 14 years with a mean age of 8.2 years. Initial symptoms, present in all patients, were abdominal pain, abdominal distension, and tenderness. Laboratory and radiological findings including abdominal radiographs and abdominal ultrasonography were nondiagnostic. Selective superior mesenteric angiography showed complete obliteration of the superior mesenteric artery with absence of venous return in 1 case. Three patients with massive intestinal necrosis died of multiorgan failure or the complications of short bowel syndrome. Histological examination of the resected intestinal segments showed the typical findings of polyarteritis nodosa in 2 patients. One patient had a previous history of right femoral vein thrombosis, whereas 1 patient had no known underlying disorders predisposing vascular thrombosis. Conclusions: Mesenteric vascular occlusion is a rare but serious disease leading to death in children. The patients present with similar clinical signs, most frequent and important are acute abdominal pain, vomiting, and distension. Mesenteric vascular occlusion is a rare cause of acute abdomen in childhood, which requires urgent diagnosis and intervention. In suspected mesenteric vascular insufficiency, angiography should be performed followed by intraarterial thrombolytic infusion therapy in selected cases. When intestinal infarction is suspected, immediate surgical resection of compromised bowel is necessary with appropriate postoperative anticoagulation or treatment of any underlying disease. J Pediatr Surg 35:1161-1164. Copyright © 2000 by W.B. Saunders Company.

Intraarterial infusion therapy via a subcutaneous port for limb-threatening ischemia: a pilot study.

To present the initial results of a new percutaneously implantable catheter port system (PIPS) used for long-term intraarterial infusion therapy in patients with severe ischemic limb disease. Ten patients with deep, extended ischemic ulcerations (all 10) and osteomyelitis (6/10) of the foot received intraarterial infusions of prostaglandine E1 and antibiotics, if indicated, via a new port catheter system with the port placed subcutaneously above the groin after percutaneous introduction and the catheter tip placed into the superficial or deep femoral artery. Port implantation and repeated port access were uncomplicated. During the follow-up period (mean 11 months, range 1 week-50 months), port migration, leakage, or infection was not observed. Three catheters thrombosed and were opened by fibrinolysis with recombinant tissue plasminogen activator instilled via the port. Treatment success was achieved in 8 patients: relief from rest pain (8 patients), reduction of ulcer size (4/8), and complete healing (4/8). Limb savage rate was 80%. In 2 patients amputation could not be avoided. Selective long-term arterial infusion therapy presents a valuable therapeutic regimen for limb salvage. With the new catheter port system, repeated local intraarterial infusion is safe and simple.

化学ホルモン療法・IFN-β動注・放射線治療が著効した鼻腔悪性黒色腫の1例

The prognosis of malignant melanoma is very poor, especially when it originates in the head and neck region. Although radical surgery has been proposed as the best therapy for malignant melanoma of this area, it is difficult to perform with a sufficient safety margin because of the extensiveness of tumors and anatomical difficulties. Various methods, such as chemotherapy, radiotherapy, immunotherapy, interferon therapy and other therapies have been suggested for treatment of this disease, but there are still no well established effective therapies.We treated a 63-year-old female with malignant melanoma of the nasal cavity with chemohormonal therapy (DTIC, CDDP, MCNU and TAM), intra-arterial IFN-p infusion and radiation therapy. Because the initial treatment, involving only intra-arterial IFN-β infusion, had achieved only minor remission, we subsequently treated her with a combination of chemo-hormonal therapy, intra-arterial IFN-β infusion and radiotherapy. During the first course of this combination therapy, tumor regression occurred and the tumor almost regressed finally. Although the patient had metastasis to the right parotid gland and the cervical lymph nodes, both the primary tumor and metastatic lesions responded to this combination therapy. It was suggested that the combination of chemo-hormonal therapy, intra-arterial IFN-β infusion and radiation therapy could become a very effective treatment for malignant melanoma of the head and neck.

頭頸部腫瘍に対する後頭動脈チューブ留置術の検討

We report the results of continuous intra-arterial infusion therapy via the occipital artery, cornbined with radiotherapy, for treatment of head and neck carcinomas in three patients. An angiographic catheter was inserted retrogradely into the artery feeding tumor, via the occipital artery which is used for rotational DSA.Two of the three patients treated had temporal carcinoma and the other had maxillary sinus cancer. No complications occurred in any of the patients as a result of this procedure.This procedure was considered very useful when an approach from the superficial temporal artery was impossible due to prior treatment or direct invasion.

Virtual reality in interventional radiology

SummaryApplications of virtual reality in Interventional Radiology have largely been directed towards development of simulators for teaching and for training in catheterization procedures or for demonstrating specific interventions such as angioplasty, stent placement or intra-arterial drug infusion therapy. Primary advantages of such systems are that they provide the clinician with an opportunity to practice hand-eye coordinated catheter manipulations that previously could only be achieved during actual patient studies or in the animal laboratory. Difficulties with the systems include problems relating to modeling realistic interactions between the catheter and blood vessels and difficulties in providing the clinician with a library of vascular reconstructions demonstrating pathologies from actual patient databases. Also, because the catheterization procedure is so closely linked with imaging equipment, it is a challenge to reproduce the clinical setting insofar as the clinician feels a part of the laboratory environment. Technological developments in patient image data acquisition, image reconstruction and processing should help solve the problem of creating realistic pathological vascular data sets.

Intra–Arterial Infusion Therapy Following Alteration of Pelvic Blood Flow and Concurrent Radiation Therapy for Invasive Bladder Cancer

Intra-arterial infusion therapy following alteration of pelvic blood flow and concurrent radiation therapy was performed in 13 patients with muscle invading bladder cancer (T2, 2; T3, 6; T4, 5). The internal iliac artery of the opposite side was embolized and the ipsilateral gluteal and obturator arteries were embolized by metallic coils. A catheter was placed in the ipsilateral internal iliac artery. CDDP was administered daily at a dose of 7-9 mg/body over 1 minute. Radiation was done by Microtron using 10 MV x-ray. Total dose was 4500-7060 cGy. Evaluation was done by cystoscopy, radiography and biopsy. Eight patients achieved complete response (CR) histologically. Others had partial response (PR). All CR patients had no recurrence. The observation period was between 3 and 29 months, with a mean of 11 months. This treatment modality is effective for locally advanced bladder cancer.

Combined intraarterial cisplatin infusion and radiation therapy for invasive bladder cancer.

Combined intraarterial cisplatin infusion and radiation therapy were performed as the initial treatment for 23 patients (mean age: 70 years) with invasive bladder cancers (T2 in 17, T3 in 6) who were suitable for total cystectomy. Of these patients, five who had multiple invasive cancers without laterality had their intrapelvic hemodynamics altered by embolizing a contralateral internal iliac artery. Cisplatin (50 mg) was infused into the internal iliac artery through a subcutaneous reservoir twice a week over three weeks while concurrent radiation therapy with 30 Gy, delivered in 15 fractions, was performed. Additional cisplatin infusions were given in six patients. After this combined therapy, total cystectomy and ileal conduit was performed in six patients and transurethral resection of bladder tumor (TURBT) in 17. Two of the patients who underwent total cystectomy were found to exhibit a complete response. Therefore, the overall response rate was 87%, including 13 complete responses and seven partial responses. The complete response rates in patients with clinical stage T2 and T3 disease were 53 and 67%, respectively. The complete response rate was slightly higher in patients with a non-papillary cancer than in those with a papillary one. Toxic reactions included a decrease in bladder capacity in two patients and severe diarrhea due to methicillin-resistant Staphylococcus aureus colitis in one. Other forms of toxicity, including nausea, vomiting, neurotoxicity in the gluteal region, nephrotoxicity and myelosuppression, were tolerable. All but one of the patients are alive.(ABSTRACT TRUNCATED AT 250 WORDS)

超選択的カテーテルを用いた脳塞栓急性期例に対するｔＰＡ動注療法 再開通により著効を呈した１例

This paper reports on a case of acute occlusion of the middle cerebral artery in which successful recanalization was achieved by intraarterial infusion of tPA with marked symptomatic improvement. The patient was a 45-year-old female with a history of mitral valve replacement. She suddenly developed left hemiplegia accompanied by dysarthria during daytime activities. An initial CT scan conducted one hour after the onset showed a small low density area in the right thalamus, which was not considered to have been newly formed after the symptom onset. Carotid angiography taken two and a half hours after the stroke manifested a complete occlusion in the M1 portion of the right middle cerebral artery. Then, a superselective catheter was immediately introduced into the middle cerebral artery and guided to the site of embolism for the intraarterial infusion of tPA (300×104IU). Complete recanalization was noted 60 minutes later. The left hemiplegia and dysarthria diminished and finally disappeared several hours after the tPA infusion. This paper discusses the indications and procedures for intraarterial tPA infusion therapy, selectively reviewing the literature. The importance of combination therapy and correct posttreatment is emphasized.

Selective accumulation and tumoricidal effect of cisplatin suspended in viscous ethyl oleate on hepatic cancers in animals after intraarterial infusion.

The selective accumulation and tumoricidal effects of cisplatin after intra-arterial infusion suspended in viscous ethyl oleate (VEO) on hepatic cancers of AH 272 tumor-bearing rats and VX-2 tumor-bearing rabbits were compared with those of cisplatin suspensions in ethyl oleate (EO) and Lipiodol Ultra Fluide (LP). The viscosities of VEO, EO and LP were 120, 4, and 21 centipoise (cp) respectively. Complete in vitro release of cisplatin from EO and LP occurred within 24 h, whereas only about 25% of cisplatin was released from VEO over the same period. When EO or VEO containing 3H-oleic acid were infused into the hepatic artery of rat liver inoculated with AH 272 tumor cells, radioactivity in the tumor site was higher than that in normal liver. In the case of cisplatin, concentration ratios after the infusion of EO and VEO were almost the same as those of oily carriers. Similar results were obtained in rabbit liver inoculated with VX-2 tumor cells. Cisplatin concentration in the tumor site seven days after intra-arterial infusion of VEO suspension was 5- and 1.7-fold higher, respectively, than that after EO and LP suspensions. The tumoricidal effect of cisplatin in VEO suspension on AH 272 tumor-bearing rats was higher than that after cisplatin solution and EO and LP suspensions, while VX-2 tumor growth was inhibited by the infusion of all cisplatin-containing oily carriers. VEO suspension thus appears very promising in intra-arterial infusion therapy.

SYNCHRONOUS DOUBLE CANCER OF THE EXTRAHEPATIC BILE DUCT AND LUNG -REPORT OF A RESECTED CASE ON A TWO-STEP APPROACH-

Recently double cancer has been increasingly reported with an increase in the aged population, an advance of diagnostic instruments and a technical improvement of cancer therapy.It is exceedingly rare that synchrous double cancer of the bile duct and lung has been successfully resected. This paper describes a resected case of synchronous cancer of extrahepatic bile duct (adenocarcinoma) and lung (squamous cell carcinoma).A 68-year-old man was admitted to the hospital for close examination because of bloody phlegm, a tumorous lesion on a X-ray film, and jaundice. By TBLB, a tumor of the left lower lobe was diangosed as squamous cell carcinoma. By PTCS biopsy, a stenosis of the distal bile duct was diagnosed as moderately differentiated adenocarcinoma. A preoperative diagnosis of synchronous double cancer of the bile duct and lung was made.It was judged impossible to resect the both carcinomas on an one-step approach in terms of surgical invasion. Intra-arterial infusion therapy with CDDP via the left bronchial artery was performed for the lung carcinoma, followed by left lower lobectomy with combined resection of the chest wall and ribs 42 days after pancreato-duodenectomy.It is generally accepted that we must give a surgical priority to the more advanced cancer responsible for the prognosis of the patient carrying synchronous double cancer.Multidisciplinary treatment and aggresive surgical intervention may bring the patient a long-term survival and favorable prognosis.