Intra-arterial Cisplatin Chemotherapy Research Articles

Impact of immunohistochemistry-based molecular subtype on predicting chemotherapy response and survival in patients with T1 stage bladder cancer after bladder-preserving treatment.

To explore the immunohistochemistry-based molecular subtypes of bladder cancer, and their impact on the prognosis and the chemotherapy response between gemcitabine plus cisplatin intra-arterial chemotherapy and epirubicin-inducted intravesical chemotherapy, in patients with T1 stage bladder cancer after bladder-preserving treatment. One hundred and seventy-six patients with T1 stage bladder cancer were selected for this study. Thirty-three patients underwent radical cystectomy, 43 received gemcitabine plus cisplatin intra-arterial chemotherapy and 100 received intravesical chemotherapy. The markers labeled with luminal (GATA3, Uroplakin II, CK20) and basal (CK5/6, CK14, CD44) phenotypes were chosen as candidate markers. One hundred and seventy-six patients were divided into 76 patients as basal/squamous (BASQ), 45 as the luminal A and 55 as the luminal B. Compared with the luminal B and BASQ tumors, the luminal A tumors showed a trend for better recurrence-free survival (P=0.105) and progression-free survival (P=0.093). The combination of CK20 and GATA3 was practical to identify the molecular phenotypes with total 84.9% accuracy and significantly associated with recurrence-free survival (P=0.025) and progression-free survival (P=0.004). The patient with BASQ tumors who received intravesical chemotherapy showed a trend for worse progression-free survival than the patient who received gemcitabine plus cisplatin intra-arterial chemotherapy or radical cystectomy. Furthermore, the patients with BASQ tumors experienced a significant improvement in progression-free survival after gemcitabine plus cisplatin intra-arterial chemotherapy compared with the patients who received intravesical chemotherapy (P=0.011). The immunohistochemistry-based molecular subtypes could predict the patient's prognosis and clinically different chemotherapeutic survival outcomes in patients with T1 stage bladder cancer after bladder-preserving treatment.

The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer.

To investigate the effects of intra-arterial chemotherapy on T1 stage bladder cancer (Bca) and evaluate patient outcome with bladder-preserving treatment approaches. A total of 238 patients with T1 stage Bca were retrospectively analyzed. Among them, 35 patients were categorized into the subgroup of highest-risk T1 stage according to the European Association of Urology guidelines and received immediate radical cystectomy (RC group), whereas 62 were classified as being highest-risk T1 patients but were unwilling to undergo RC and were treated with gemcitabine plus cisplatin intra-arterial chemotherapy (GC group). There were 141 T1 patients who had bladder-preserving surgery with intravesical chemotherapy (IVC group). For patients with T1 stage Bca, the GC group had a higher estimated recurrence-free survival rate (44.4 vs. 13.9%, P=0.087), progression-free survival rate (75.4 vs. 32.8%, P=0.006), and cancer-specific survival (CSS) rate (78.7 vs. 67.5%, P=0.399) when compared with the IVC group, respectively. Using the multivariable regression model, the GC intra-arterial chemotherapy was significantly related to bladder preservation (P=0.004), lower recurrence (P=0.012), and less progression (P=0.004). For patients with the highest-risk T1 stage, GC group did not have a poorer CSS rate in comparison with the RC group (P=0.383). Moreover, immediate RC did not confer a survival benefit in terms of CSS when compared with those who underwent deferred RC after failing GC intra-arterial chemotherapy (P=0.283). Gemcitabine plus cisplatin intra-arterial chemotherapy may be an effective bladder-preserving alternative adjuvant treatment for patients with T1 stage Bca with oncologic benefits, good compliance, and low toxicity.

English

We investigate the relationship of SNPs in XRCC1, ERCC1 and ERCC2 to methotrexate intravenous adriamycin and intra-arterial cisplatin chemotherapy response and survival in bone cancer patients. 281 consecutive patients diagnosed with bone tumor between January 2003 to January 2005, and they were followed up until the end of January 2010. Polymorphisms in XRCC1Arg280His, XRCC1Arg399Gln, ERCC1 Asn118Asn, ERCC1 Gln504Lys, ERCC2 Asp312Asn and ERCC2 Lys751Gln were detected based upon Sequenom MassARRAY platform. All 281 patients were followed up until the end of January 2010. The median follow-up time was about 43.9 months. Our study showed a longer survival rate in XRCC1 399 Arg/Arg genotype than Gln/ Gln, and with a significant increased death risk (HR=0.46, 95%CI=0.31-0.96). For ERCC1 Asn118Asn, the variant genotype T/T was strongly significantly associated with a higher event free survival when compared with the wide-type C/C, with the adjusted OR (95% CI) of 0.33(0.15-0.97). ERCC2 751 A/A genotype showed increased the event free survival of osteosarcoma (HR=0.45; 95%CI=0.15-0.91), and T allele genotype of ERCC2 Lys751Gln was significantly associated with low risk of death from osteosarcoma (HR=0.53, 95%CI= 0.28-0.95). This study is the first time to report the ERCC1 and ERCC2 gene polymorphisms might well be useful as a surrogate marker of clinical outcome in bone cancer.   Key words: DNA repaired gene, polymorphisms, osteosarcoma, chemotherapy, response.

Platinum concentration in sentinel lymph nodes after preoperative intra-arterial cisplatin chemotherapy targeting primary tongue cancer

Conclusion: We conclude that intra-arterially injected cisplatin passed via lymph flow into sentinel nodes (SNs) as the platinum concentration in the SNs was higher than that in the non-sentinel nodes (NSNs). It is possible that preoperative intra-arterial chemotherapy targeting primary cancer also has a therapeutic effect on subclinical metastatic SNs. Objectives: Intra-arterial chemoradiotherapy has been reported to be effective against not only primary tumors but also nodal metastases. We considered the hypothesis that intra-arterially injected cisplatin passed via lymph flow into regional nodes. This study aimed to investigate intra-arterially injected cisplatin distribution to regional nodes by comparing platinum concentrations in SNs and NSNs. Methods: Five patients with T1-2 N0 tongue cancer were treated with preoperative intra-arterial chemotherapy (cisplatin, 100 mg/m2) targeting primary cancer. Partial glossectomy together with SN biopsy and elective neck dissection were performed 2 weeks after intra-arterial chemotherapy. Platinum concentrations in the lymph nodes were measured using a Zeeman atomic absorption spectrometer. Results: Thirteen SNs were harvested together with eight NSNs from the areas adjacent to the SNs. Platinum concentrations were then measured, revealing a significant difference in platinum concentration between the SNs and the NSNs (mean ± SD, 0.682 ± 0.246 µg/g vs 0.506 ± 0.274 µg/g; p = 0.049).

A pilot study of high‐dose intraarterial cisplatin chemotherapy with concomitant accelerated radiotherapy for patients with previously untreated T4 and selected patients with T3N0–N3M0 squamous cell carcinoma of the upper aerodigestive tract

This Phase I clinical trial was developed to assess the feasibility of combining high-dose intraarterial cisplatin chemotherapy with concurrent, concomitant boost accelerated radiation therapy for patients with previously untreated T4 and select patients with T3N0-N3M0 squamous cell carcinoma of the upper aerodigestive tract. Between July 1999, and February 2002, 19 patients were treated with 3 or 4 weekly cycles of intraarterial Cisplatin chemotherapy (150 mg/m(2)) with concurrent, concomitant boost accelerated radiation therapy (72 grays in 42 fractions over 6 weeks). Two patient deaths occurred among the first 15 patients enrolled. Both patients presented with febrile neutropenia, and both died of complications related to infection. The number of cycles of intraarterial cisplatin was reduced from four cycles to three cycles, and an additional four patients were treated. The fourth patient treated on the modified protocol developed febrile neutropenia, sepsis, and a thromboembolic event, which resulted in lower extremity amputations. The maximum acute toxicity experienced was Grade 2 in 6 patients, Grade 3 in 5 patients, Grade 4 in 6 patients, and Grade 5 in 2 patients. With a median follow-up of 21 months (range, 6.2-34.6 months), the overall survival at 1 year was 89.5% (95% confidence interval [95%CI], 76.7-100%). At 1 year, 92.9% of the patients were free from disease progression (95%CI, 80.3-100%). The results of this study suggest that concurrent intraarterial cisplatin chemotherapy at a dose of 150 mg/m(2) with concomitant boost accelerated radiation therapy is not feasible.

Is high‐dose intensity intraarterial cisplatin chemoradiotherapy for head and neck carcinoma feasible?

The author outlines his personal experience treating hundreds of patients with head and neck carcinoma using combined high‐dose intraarterial cisplatin chemotherapy and concomitant, radiation therapy, and he also highlights the published experience of other investigators, all of whom concluded that the high‐dose intensity approach is feasible and highly efficacious. This differs from the results reported in this issue by a group of investigators from the Mayo Clinic.See referenced original article on pages 559–68, this issue.

Intra-arterial effects of cisplatin on microvascular anastomoses in the rat model.

To evaluate the patency of microvascular anastomoses in arteries exposed to intra-arterial cisplatin. Animal model. The common iliac artery of 15 rats was injected with 150 mg/m(2) cisplatin. Five rats were injected with the same volume of saline serving as physiological controls. The ipsilateral femoral artery was transected and anastomosed using microsurgical technique within 3 to 5 days. A Doppler probe was used before and after the anastomosis to assess blood flow. The vessel was re-examined on postoperative day 5. Pulsatile blood flow and the presence or absence of a Doppler signal was recorded at this time. Vessels were harvested to include the anastomosis site and fixed for histological evaluation. The contralateral femoral artery was also harvested for comparison. All femoral artery anastomoses in the experimental and control arm had good, pulsatile blood flow by microscopic evaluation. No thrombosed vessels were visualized, and Doppler signals remained strong at all vessel anastomoses. Histological analysis of the vessels revealed a trend toward increased inflammatory infiltrate in the walls of the vessels treated with cisplatin. We did not appreciate a functional decrease in lumen size. Selective catheterization intra-arterial cisplatin chemotherapy does not affect the patency of vessels following a microvascular anastomosis in the rat model. The trend toward increased inflammatory response in the vessel walls may suggest the need for closer monitoring in patients treated with intra-arterial chemotherapy.

Long-term complete remission of melanoma liver metastases after intermittent intra-arterial cisplatin chemotherapy and surgery

This paper presents the case of a female patient with liver metastases of a malignant melanoma showing complete remission after 10 courses of regional, intra-arterial chemotherapy with cisplatin. The drug was administered as continuous infusion for 5 days. The daily dosage amounted to 30 mg/m2. The interval between courses was 6 weeks. Nausea and vomiting were seen after each course, while pathological serum creatinine levels only appeared after the eighth course. The only lesion in the liver still visible on CT scan after chemotherapy was removed by left hemihepatectomy. Meticulous histological examination revealed a big focus of necrotic tissue without any tumour cells. At the time of publication the patient is alive and disease-free over 9 years later.

The Role of Endorectal Ultrasonography in the Follow-up Evaluation of the Uterine Cervical Carcinomas in Intra-arterial Cisplatin Chemotherapy

The Role of Endorectal Ultrasonography in the Follow-up Evaluation of the Uterine Cervical Carcinomas in Intra-arterial Cisplatin Chemotherapy

Intra-arterial Cisplatin Chemotherapy in Uterine Cervix Cancer after Selective Internal lilac Arteriography

Intra-arterial Cisplatin Chemotherapy in Uterine Cervix Cancer after Selective Internal lilac Arteriography

Case report 669

A case is presented of an 18-year-old women who suffered pain and swelling after intraarterial cisplatin chemotherapy for osteosarcoma of the left fibula. Radiological studies showed minimal changes at the metadiaphyseal portion of the left tibia. Bone scans and MR studies were highly suggestive of necrosis of bone and muscle of the proximal end of the tibia. Multiple biopsies of the tibia at the time of excision and 2 years later showed histological features consistent with a slowly healing osteonecrosis of bone. Review of the literature reported transient pain and swelling after intraarterial chemotherapy but did not demonstrate the association with necrosis of bone and muscle. It can be anticipated that as intraarterial chemotherapy of malignant tumors of bone and soft tissues becomes more widely used, these complications will be observed more frequently.

Technical note: Brachial plexopathy as a complication of intraarterial cisplatin chemotherapy

Intraarterial administration of chemotherapeutic agents provides greater local concentration at the tumor site without increased systemic toxicity. Although intravenous infusion of cisplatin is known to cause peripheral neuropathy and intraarterial administration has been reported to cause lumbosacral plexopathy, brachial plexopathy has not been described. We present a case in which infusion of cisplatin into the axillary artery resulted in permanent neurological damage to the posterior cord of the brachial plexus. Proper positioning of the infusion catheter is necessary to minimize potential neural damage.

Synthesis of [13N]cisplatin

AbstractA method for the “carrier‐added” synthesis of [13N]cisplatin is described. Yields were ∼1–4 mCi from 20–40 mCi of [13N]ammonia with a total synthesis time of 19–28 minutes. The product was ∼96% radiochemically pure as judged by HPLC analysis and had a specific activity of ∼100 mCi/mmole in 1.0 ml of saline. [13N]Cisplatin was administered intraperitoneally to mice. Of the tissues investigated, concentration of label was highest in kidneys. At 10 min, considerable label in the blood, liver, and kidney was in a form other than cisplatin. However, no evidence was obtained that [13N]ammonia was released from [13N]cisplatin in vivo. [13N]Cisplatin may be used to assess drug delivery to primary and metastatic brain tumors in patients receiving intravenous or intraarterial cisplatin chemotherapy.