Port-catheter System Research Articles

IMMU-22. B7-H3 NANOBODY CAR-T AND SOLUBLE TREM2 GENETICALLY ENGINEERED MYELOID CELL THERAPY IN MURINE SYNGENEIC GLIOBLASTOMA

Abstract BACKGROUND Myeloid immunosuppression can be a major impediment to CAR-T cell therapy for CNS tumors. Importantly, CAR-T cells are often evaluated in immunocompromised mice which cannot accurately recapitulate the tumor immune response or tumor microenvironment. CNS tumor macrophages express TREM2, an important driver of immunosuppression. This study combines B7-H3 targeting nanobody CAR-T cells which are cross reactive in humans and mice (currently being evaluated for clinical development) with genetically engineered myeloid cells (GEMys) expressing soluble TREM2 (sTREM2) in a syngeneic mouse model of glioblastoma (GBM), with the aim of blocking TREM2-mediated immunosuppression to enhance CAR-T cell function. METHODS Syngeneic murine GBM, designed to mimic human GBM and generated at the Center for Advanced Preclinical Research (CAPR), was used for all studies. B7-H3 nanobody CAR-T cells were generated from mouse splenic T cells. In vitro tumor killing assays were performed by xCELLigence. sTREM2 GEMys were generated from bone marrow progenitor cells using lentiviral transduction. For in vivo studies, mice underwent orthotopic implantation of tumors and placement of an MRI-compatible, permanent catheter-port system for serial intracerebroventricular (ICV) administration of cell therapies. Mice were treated with CAR-T and/or GEMy therapies, evaluated weekly for tumor burden by MRI, and were monitored for survival. RESULTS Syngeneic GBM expression of B7-H3 was confirmed by flow cytometry, immunofluorescence, and western blot. B7-H3 nanobody CAR-T cells demonstrated effective killing of GBM by xCELLigence. sTREM2 GEMys were successfully generated and confirmed to produce sTREM2. Cell therapies were successfully infused ICV via the implanted catheter-port system, demonstrating safety and feasibility of this model for serial ICV cellular therapy. CONCLUSIONS B7-H3 nanobody CAR-T cells were validated against syngeneic GBM, and we have demonstrated safety and feasibility of ICV catheter administration of cellular therapies in vivo. Future studies will continue to evaluate in vivo timing and efficacy of CAR-T and GEMy therapy.

Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach.

In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.

A Case of Bilateral Internal Mammary Arterial Infusion Chemotherapy Using Implantable Port-catheter Systems for Anterior Chest Wall Metastasis of Breast Cancer

The patient was a 53-year-old woman who presented with a metastatic tumor of the anterior chest wall after chemotherapy for right accessory breast cancer and radiation therapy for right axillary lymphadenopathy. She had already received standard treatment, but the metastatic tumor was uncontrollable and exacerbated. Palliative treatment by arterial infusion chemotherapy with an implantable catheter-port system was planned. We indwelled a port system through the arteries because the bilateral internal mammary arteries presented a dominant blood supply. The metastatic tumor almost disappeared by arterial infusion chemotherapy after 3 months. This method may be effective in selected cases of arterial infusion chemotherapy for breast cancer.

Repeated trans-arterial treatments of LDL-DHA nanoparticles induce multiple pathways of tumor cell death in hepatocellular carcinoma bearing rats.

Repeated hepatic arterial delivery of therapeutic agents to the liver by percutaneously implanted port-catheter systems has been widely used to treat unresectable liver cancer. This approach is applied to assess the therapeutic efficacy of repeated low-density lipoprotein-docosahexaenoic acid (LDL-DHA) nanoparticle treatments in a rat model of hepatocellular carcinoma. N1S1 hepatoma bearing rats underwent placement of a percutaneously implanted hepatic artery port-catheter system and were allocated to untreated, control LDL-triolein (LDL-TO) or LDL-DHA nanoparticle infusions groups. Treatments were performed every three days over a nine day study period. MRI was performed at baseline and throughout the study. At the end of the study tissue samples were collected for analyses. Implantation of the port catheters was successful in all rats. MRI showed that repeated infusions of LDL-DHA nanoparticles significantly impaired the growth of the rat hepatomas eventually leading to tumor regression. The tumors in the LDL-TO treated group showed delayed growth, while the untreated tumors grew steadily throughout the study. Histopathology and MRI support these findings demonstrating extensive tumor necrosis in LDL-DHA treated groups while the control groups displayed minor necrosis. Molecular and biochemical analyses also revealed that LDL-DHA treated tumors had increased levels of nuclear factor-kappa B and lipid peroxidation and depletion of glutathione peroxidase 4 relative to the control groups. Evidence of both ferroptosis and apoptosis tumor cell death was observed following LDL-DHA treatments. In conclusion repeated transarterial infusions of LDL-DHA nanoparticles provides sustained repression of tumor growth in a rat hepatoma model.

Usefulness of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position: a new technique for cases unsuitable for conventional implantation

PurposeTotally implantable central venous access port implantation is typically performed in the supine position. However, some patients cannot adopt the supine position due to severe pain and/or dyspnea. The present study evaluated the technical feasibility of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position in such cases.Materials and methodsIn the sitting position method, PICC-PORT implantation was performed with the patients seated on a videofluoroscopy chair positioned between the limbs of an angiographic C-arm and the operative upper arm positioned on an arm stand.From January 2019 to September 2021, eight patients underwent PICC-PORT implantations using this sitting method. We also evaluated 251 consecutive patients with conventional supine position PICC-PORT implantation as controls. Differences in technical success, procedure time and complications were retrospectively assessed between the two groups.ResultsProcedural success rates were 100% in both groups. Median procedure times in the sitting and conventional groups were 42 and 44 min, respectively. No complications were observed in the sitting group. There were no significant differences between the two groups in procedure time (p = 0.674) and complications (p = 1.000).ConclusionImplantation of PICC-PORT in the sitting position is technically feasible and useful.

Sorafenib Plus Hepatic Arterial Infusion Chemotherapy versus Sorafenib for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis: A Randomized Trial

Background The prognosis of hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT) is dismal after standard treatment with sorafenib. Hepatic arterial infusion chemotherapy (HAIC) has been suggested for patients with HCC and major PVTT. Purpose To compare the efficacy and safety of sorafenib plus 3cir-OFF HAIC versus sorafenib alone for advanced HCC with major PVTT. Materials and Methods This phase II trial recruited systemic treatment-naïve patients with HCC and major PVTT (portal vein invasion grade Vp3 [first branch] and Vp4 [main trunk]) between June 2017 and November 2019. Patients were randomly assigned (1:1 ratio) to receive sorafenib (400 mg twice daily) plus 3cir-OFF HAIC (35 mg/m2 oxaliplatin [hours 0-2] followed by 600 mg/m2 5-fluorouracil [hours 2-24], days 1-3) with a standardized percutaneous port catheter system or sorafenib alone (400 mg twice daily) every 4 weeks. The primary end point was overall survival (OS). The secondary end points were objective response rate, progression-free survival (PFS), and safety. OS and PFS were assessed using the Kaplan-Meier method and log-rank test. Results The intent-to-treat population included 64 patients, with 32 in each group. The median OS was 16.3 months (95% CI: 0.0, 35.5) with sorafenib plus HAIC and 6.5 months (95% CI: 4.4, 8.6) with sorafenib alone (hazard ratio [HR] = 0.28; 95% CI: 0.15, 0.53; P < .001). A higher objective response rate (41% [n = 13] vs 3% [n = 1], P < .001) and a longer median PFS (9.0 months vs 2.5 months; HR = 0.26; 95% CI: 0.15, 0.47; P < .001) were observed in the sorafenib plus HAIC group. Grade 3 or 4 adverse events were more frequent in the sorafenib plus HAIC group, including diarrhea (n = 7 [22%] vs n = 5 [16%]), hand-foot syndrome (n = 6 [19%] vs n = 2 [6%]), and thrombocytopenia (n = 7 [22%] vs n = 0). Conclusion Sorafenib plus 3cir-OFF hepatic arterial infusion chemotherapy may be a promising treatment in patients with hepatocellular carcinoma and major portal vein tumor thrombosis because of the improved survival and an acceptable safety profile. Clinical trial registration no. NCT03009461 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chung in this issue.

Our central venous port catheter system practice - a retrospective study.

To evaluate indications for insertion, complications and indications of central venous port catheters, and to identify indications for their removal. The retrospective study was conducted at Okmeydani Training and Research Hospital, Istanbul, Turkey, and comprised data from January 2006 to June 2014 of patients who had central venous port catheters. The indications for removal of the catheters were also evaluated. Of the 1198 patients whose records were reviewed, 605(50.5%) were women and 593(49.5%) were men. The overall mean age was 52.3±12.78 years. Of the total, 1142(95.33%) cases related to chemotherapy treatment. There were 127(10.6%) complications; the most common being catheter occlusion 46(36.2%). The catheters were removed in 182(15.2%) patients. Among them, 83(45.6%) catheters were removed because they were no more needed. In the light of the findings, there is a need for standardised guidelines for evaluation before central venous port catheter insertion and follow-up after insertion to detect and to avoid possible complications.

A rare cause of stroke: fail-implanted venous port catheter system \u2013 a case report

BackgroundWe present the case of a 75-year-old female with acute embolic cerebral infarction caused by a fail-implanted venous port catheter system in the left subclavian artery.Case presentationA 75-year-old woman presented to our emergency room after acute onset of a right-sided hemiparesis and dysarthria. Within 2 days after admission, she developed a left-sided hemiparesis, ataxia with concordant gait disturbance and incoordination of the left upper limb. DWI-MRI showed acute multiple infarcts in both cerebral and cerebellar hemispheres. Laboratory examination, 24-h Holter electrocardiography and transthoracic echocardiography provided no pathological findings. Further examination revealed an arterially fail-implanted port catheter, placed in the left subclavian artery with its tip overlying the ascending aorta, as the source of cerebral embolism.ConclusionThis is the first case report of thromboembolic, cerebral infarction due to a misplaced venous port catheter in the subclavian artery, emphasizing the imperative need for a thorough diagnostic workup, when embolism is suspected but cannot be proven at first glance.

Percutaneous Implantation of a Microcatheter-Port System for Hepatic Arterial Infusion Chemotherapy of Unresectable Liver Tumors: Technical Feasibility, Functionality, and Complications.

To evaluate the feasibility and safety of percutaneously implanted arterial port catheter systems for hepatic arterial infusion of chemotherapy (HAI) in patients with unresectable liver malignancies. From October 2010 to August 2018, arterial port catheters for HAI were percutaneously implanted in 43 patients with unresectable liver malignancies. Three different catheter placement techniques were compared: a conventional end-hole catheter placed in the common hepatic artery (technique 1, n = 16), a side-hole catheter with the tip fixed in the gastroduodenal artery (technique 2, n = 18), and a long-tapered side-hole catheter with the tip inserted distally in a segmental hepatic artery (technique 3, n = 6). Catheter implantation was successful in 40 (93%) of the 43 patients. Complications related to catheter placement were observed in 10 (23%) patients; 5 (83%) of the 6 major complications were resolved, as well as all 4 minor complications. Catheter migration and occlusion occurred in 9 (22.5%) patients. Catheter migration was more frequent with technique 1 (n = 6) than with technique 2 (n = 1), although the difference was not significant (p = 0.066). Percutaneous arterial port catheter implantation for HAI is highly feasible and carries a low risk of complications.

Survival Benefit of Hepatic Arterial Infusion Chemotherapy over Sorafenib in the Treatment of Locally Progressed Hepatocellular Carcinoma.

Simple SummaryNot all patients with hepatocellular carcinoma (HCC) benefit from treatment with systemic treatments such as sorafenib. Hepatic arterial infusion chemotherapy (HAIC) is the treatment using an indwelling catheter port system. The regimen of HAIC used in the study is New FP which is consisted of a fine-powder cisplatin and 5-fluorouracil. In the study, for the patients with locally progressed HCC, such as HCC with vascular invasion, initial administration of local hepatic treatment using HAIC was superior to systemic treatment using sorafenib.BACKROUND: Not all patients with hepatocellular carcinoma (HCC) benefit from treatment with molecular targeted agents such as sorafenib. We investigated whether New-FP (fine-powder cisplatin and 5-fluorouracil), a hepatic arterial infusion chemotherapy regimen, is more favorable than sorafenib as an initial treatment for locally progressed HCC. METHODS: To avoid selection bias, we corrected the data from different facilities that did or did not perform New-FP therapy. In total, 1709 consecutive patients with HCC initially treated with New-FP or sorafenib; 1624 (New-FP, n = 644; sorafenib n = 980) were assessed. After propensity score matching (PSM), overall survival (OS) and prognostic factors were assessed (n = 344 each). Additionally, the patients were categorized into four groups: cohort-1 [(without macrovascular invasion (MVI) and extrahepatic spread (EHS)], cohort-2 (with MVI), cohort-3 (with EHS), and cohort-4 (with MVI and EHS) to clarify the efficacy of each treatment. RESULTS: New-FP prolonged OS than sorafenib after PSM (New-FP, 12 months; sorafenib, 7.9 months; p < 0.001). Sorafenib treatment, and severe MVI and EHS were poor prognostic factors. In the subgroup analyses, the OS was significantly longer the New-FP group in cohort-2. CONCLUSIONS: Local treatment using New-FP is a potentially superior initial treatment compared with sorafenib as a multidisciplinary treatment in locally progressed HCC without EHS.

Safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis and tuberculosis with extended resistance

Background. Yu-Port (“Yuria-Pharm”) is an implanted system for long-term infusions. This system allows multiple access to vessels for parenteral administration of drugs, fluids and nutrient solutions.&#x0D; Objective. To describe the safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis (TB) and TB with extended resistance.&#x0D; Materials and methods. Analysis of the literature on this issue.&#x0D; Results and discussion. Prolonged venous access is required in case of long-term infusion therapy or chemotherapy, as well as with the use of drugs that irritate the veins. Routine methods of vascular access have a number of disadvantages: the needle of the system damages the vessel with each injection; infusion cannula should be replaced every 3-5 days; the central venous catheter cannot be installed permanently (on average, for 1 week). Therefore, port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. When installing the port system, the catheter is in the vein, the port is under the skin, and the needle is brought out. The advantages of the Yu-Port system include a large silicone membrane, fluid flow rate of 5 ml/s, compatibility with magnetic resonance imaging, and the absence of latex and polyvinyl chloride. The Yu-Port package contains installation instructions and all the necessary tools. The silicone membrane allows repeated piercing only with a special Yu-Port needle or the included needle. After the puncture, the membrane is tightened, because due to a special sharpening needle does not tear the membrane material, but pushes it apart. Jugular or subclavian access is most often used to install ports. The advantages of using port systems in chemotherapy include low traumaticity, painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of developing phlebitis, long use duration (several years). Our own experience with port systems (56 patients in 2019-2020) showed significantly fewer premature treatment terminations due to side effects than in the group of standard infusion therapy (12.50 % vs. 22.6 %).&#x0D; Conclusions. 1. Port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. 2. The advantages of using port systems in chemotherapy include painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of phlebitis, long use duration. 3. In patients who need long-term or multicomponent chemotherapy, for example, in multidrug-resistant TB, it is advisable to use port systems.

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

ObjectiveThis study aimed to introduce and evaluate a new embolization technique for the right gastric artery (RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy (HAIC). MethodsFrom January 2013 to January 2017, 159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 86 of these patients (56 men; aged 28–88 years; mean: 60.6 ​± ​12.0 years), in whom the RGA was obvious on arteriography, embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC. In the first phase (first three years), antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients. In the second phase (next two years), embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery (LGA) in 31 patients. The success rates and the incidence of acute gastroduodenal mucosal toxicity (AGMT) in these two groups were compared. ResultsThe total success rate of the RGA embolization was 70.9%. The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization, which was significantly higher than that of antegrade embolization alone (63.6%) performed in 55 patients (p ​= ​0.047). No complications related to embolization of RGA were documented. The incidence of AGMT was 29.1% (16/55) in patients in the first phase, which was significantly higher than that in the patients in the second phase (9.7%, 3/31) (p ​= ​0.037). ConclusionA combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.

Hepatic arterial infusion oxaliplatin plus oral S-1 chemotherapy to improve prognosis for gastric cancer with multiple liver metastases.

e16508 Background: Gastric cancer with multiple liver metastases (GCLM) is associated with a high disease burden with synchronous or metachronous tumour invasions of other organs. In order to improve patient outcome, this study combined hepatic artery infusion (HAI) oxaliplatin with oral S-1 chemotherapy as a first-line palliative therapy. The aim is to assess efficacy and safety of this combination mode. Methods: We reviewed the records of ten patients with GCLM who received HAI oxaliplatin (70-80 mg/m2 2h d1,15) administered via a port-catheter system and S-1 with oral (35-40 mg/m2 twice daily for d1-14, 28 days for one cycle). Follow-up examination and efficacy evaluation were executed periodically. Results: Until the 4th cycle response evaluation, the local effective rate and control rate was 60% and 90% respectively, only one patient developed progression. HAI oxaliplatin plus oral S-1 chemotherapy had a better local control against hepatic metastases (median progression-free survival: hepatic, 9.0 months vs. extrahepatic, 6.5 months), which showed potential benefit of the combination regimen in gaining local tumour control, maintaining function and improving life quality. Conclusions: HAI oxaliplatin plus oral S-1 chemotherapy can be regarded as an optimized treatment strategy for GCLM, which is also a crucial way for controlling of extrahepatic lesions without much systemic toxicity.

An implanted port-catheter system for repeated hepatic arterial infusion of low-density lipoprotein-docosahexaenoic acid nanoparticles in normal rats: A safety study

BackgroundIn recent years, small animal arterial port-catheter systems have been implemented in rodents with reasonable success. The aim of the current study is to employ the small animal port-catheter system to evaluate the safety of multiple hepatic-artery infusions (HAI) of low-density lipoprotein-docosahexaenoic acid (LDL-DHA) nanoparticles to the rat liver. MethodsWistar rats underwent surgical placement of indwelling HAI ports. Repeated administrations of PBS or LDL-DHA nanoparticles were performed through the port at baseline and days 3 and 6. Rats were sacrificed on day 9 at which point blood and various organs were collected for histopathology and biochemical analyses. ResultsThe port-catheter systems were implanted successfully and repeated infusions of PBS or LDL-DHA nanoparticles were tolerated well by all animals over the duration of the study. Measurements of serum liver/renal function tests, glucose and lipid levels did not differ between control and LDL-DHA treated rats. The liver histology was unremarkable in the LDL-DHA treated rats and the expression of hepatic inflammatory regulators (NF-κβ, IL-6 and CRP) were similar to control rats. Repeated infusions of LDL-DHA nanoparticles did not alter liver glutathione content or the lipid profile in the treated rats. The DHA extracted by the liver was preferentially metabolized to the anti-inflammatory DHA-derived mediator, protectin DX. ConclusionOur findings indicate that repeated HAI of LDL-DHA nanoparticles is not only well tolerated and safe in the rat, but may also be protective to the liver.

Assessment of the Antithrombogenicity of a Poly-2-Methoxyethylacrylate-Coated Central Venous Port-Catheter System.

The purpose of this study was to evaluate the antithrombogenic effects of poly-2-methoxyethylacrylate (PMEA) coating applied to the internal surfaces of the port-catheter system to prevent thrombotic occlusion. PMEA coating was applied to the inner surfaces of the entire system, including the chamber, catheter, and connecting stem. PMEA-coated and uncoated port-catheter systems were each filled with fresh human blood for 1 or 3h and then flushed with saline. Volumes of residual thrombi in the system and protein in the catheter were then compared. Saline flushing of the PMEA-coated port-catheter system expelled all visually recognizable thrombi, leaving no unremovable adhesions. In contrast, the uncoated port showed thrombi adherent to the inner surfaces and incomplete expulsion with flushing. Mean (± standard deviation) residual thrombus mass was significantly lower in PMEA-coated port-catheter systems (20.5 ± 6.2mg) than in uncoated systems (230.3 ± 92.5mg; p < 0.01). Mean residual protein was likewise significantly lower in PMEA-coated systems (20.5 ± 6.2mg) than in uncoated systems (230.3 ± 92.5mg; p < 0.01). PMEA coating on a central venous port-catheter system decreased accumulation and facilitated flushing of thrombi from the system by flushing, as compared with the uncoated system. PMEA-coated central venous port-catheter systems appear relatively antithrombotic compared to uncoated systems.

Hepatic Arterial Infusion Oxaliplatin Plus Oral S-1 Chemotherapy in Gastric Cancer with Unresectable Liver Metastases: A Case Series and Literature Review.

ObjectiveThe use of hepatic artery infusion (HAI) as a regional therapy against liver metastasis has rarely been reported in gastric cancer. This study aimed to evaluate the efficacy and safety of HAI oxaliplatin plus oral S-1 chemotherapy in first-line palliative therapy for gastric cancer with multiple liver metastases (GCLM).MethodsWe reviewed the records of five patients with GCLM who received HAI oxaliplatin (70–80 mg/m2 2 hrs d1,15) administered via a port-catheter system and S-1 with oral (35–40 mg/m2 twice daily for d1-14, 28 days for one cycle). Follow-up examination and efficacy evaluation were executed periodically.ResultsUntil the 4th cycle response evaluation, the local effective rate and control rate were 40% and 80%, respectively; only one patient developed progression. HAI chemotherapy had a better local control against liver metastases (median progression-free survival: hepatic, 8.8 months vs. extrahepatic, 6.2 months), accompanied by less systemic toxicity, decreased tumour markers and symptomatic relief.ConclusionHAI oxaliplatin plus oral S-1 chemotherapy can be considered as a new choice of first-line treatment for GCLM, which is also a good approach for controlling extrahepatic lesions with less adverse events.

Evaluation of percutaneous unilateral trans-femoral implantation of side-hole port-catheter system with coil only fixed-catheter-tip for hepatic arterial infusion chemotherapy

BackgroundThe technique for arterial infusion chemotherapy (HAIC) is not standardized which limits its widely application. The aim of this study was to evaluate the long-term functionality and complications of port-catheter system using percutaneous unilateral trans-femoral implantation with coil only fixed-catheter-tip method.MethodsFrom January 2013 to January 2017, 205 consecutive patients (138 men; aged 28–88 years; mean, 59.1 ± 11.2 years) with unresectable malignant liver tumors underwent percutaneous implantation of side-hole infusion port-catheter into hepatic artery using coil only fixed-catheter-tip method via the unilateral femoral artery. Technical success, procedure time, duration of port functionality, and complications of port dysfunction were investigated.ResultsImplantation technical success was 98.5% and the procedure time was 59.1 ± 10.2 min. Predictable functionality of the port-catheter system at 6-, 12-, and 24 months were 97.5, 89.9, 70.5%, respectively. Complications of port irreversible dysfunction were hepatic artery obstruction (4.0%), catheter occlusion (3.5%), and catheter dislocation (0.5%). Median 5 HAIC cycles (range: 1–14 cycles) were received via port.ConclusionPercutaneous unilateral trans-femoral implantation of a side-hole port-catheter with coils only fixed-catheter-tip method is a simple and feasible interventional technique for HAIC which offers long-term functionality.

Complications arising from transfemoral, percutaneous implantation of an indwelling port–catheter system for hepatic infusion chemotherapy: Case series of the management and salvage of the system

IntroductionRegional hepatic arterial infusion of chemotherapy is performed for unresectable liver tumors via percutaneously implanted port–catheter systems; while these port–catheter systems are effective administration routes, they are associated with various complications. Withdrawal of the system is considered if the complications occur, but repeated hepatic arterial infusion of chemotherapy (HAIC) via an implanted port–catheter system is a last-resort treatment for unresectable advanced liver cancer, and the treatment must be continued. We discuss various cases with complications arising in the indwelling port area in hepatic arterial infusion of chemotherapy and report whether the system was salvaged. MethodsBetween August 2013 and October 2017, eight patients (six males and two females) aged 61–80 years (mean age 76.6 years) with complications arising in a transfemoral indwelling port site for HAIC were referred to our department. All patients requested preservation of the system, especially the catheter. Each patient was assessed for the presence of “gross infection” based on a comprehensive evaluation of clinical findings and blood test results. In cases of “no gross infection,” we performed catheter salvage procedures.If there was no clinical improvement following the catheter salvage procedure, the port–catheter system was withdrawn. This research work has been reported in line with the PROCESS criteria. ResultsThe port–catheter systems were withdrawn in two patients: one due to lasting infection and the other due to ulcer recurrence. Three cases were treated by removal of hematoma through an incision and ointment. The system was withdrawn in one of these cases due to exacerbation of ulcer; thus, the catheters were salvaged in five patients. None of these five patients experienced a relapse from 3 months to over 1 year after the procedure. ConclusionThe success of subcutaneous HAIC significantly impacts a patient’s prognosis, especially for unresectable tumors and residual tumor recurrences. Initially, we chose to preserve the devices without removal, particularly if there was no infection. However, this approach led to a delay in chemotherapy, prolongation of healing time, and additional complications. These cases demonstrate the importance of a thorough consultation with the patient’s oncologist to discuss whether or not the device should be conserved.

Development of Repeatable Microcatheter Access Port for Intra-arterial Therapy of Liver Cancer.

To develop an implantable port in which a microcatheter can be inserted for a combination therapy of repeated transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for advanced liver cancer. The design of a currently used implantable port was modified. A funnel part was constructed in the port. The septum was punctured by a 20-gauge indwelling needle, and 2.0-Fr non-tapered microcatheter was inserted into the port. In the in vitro studies, the advance of a microcatheter out of the funnel part was evaluated via seven different septum puncture sites. A 5-Fr indwelling catheter connected to the port was placed in a vascular model, and a microcatheter catheterization was evaluated. In an in vivo study, the port-catheter system was implanted in the hepatic artery in a pig. A microcatheter was percutaneously inserted through the port into the hepatic arterial branches, and embolization was performed. In the in vitro studies, the microcatheter was smoothly advanced out of the port and catheterizations into the hepatic arteries were successful via all septum puncture sites. In the in vivo study, repeated selective embolization through the port was successfully conducted on 7, 14 and 21days after the implantation. The developed implantable port can be used for repeated catheter insertion into the hepatic artery. The combination of repeated TACE and HAIC could be possible using this device.

Impact of adjuvant hepatic arterial infusion chemotherapy using high-dose 5-fluorouracil with systemic gemcitabine for resectable pancreatic cancer.

360 Background: Despite recent advances in cancer treatment, postoperative recurrence remains an unsolved issue for resectable pancreatic cancer. To prevent hepatic recurrence and prolong postoperative survival, we introduced postoperative adjuvant chemotherapy of high-dose 5-fluorouracil (5-FU) hepatic arterial infusion (HAI) with systemic chemotherapy using gemcitabine in 2006. We retrospectively evaluated the clinical impact of HAI. Methods: A total of 251 patients who underwent pancreatic resection for PC were analyzed. Patients received weekly high-dose 5-FU through the hepatic artery using a port-catheter system (1000 mg/m2 for 5 h) plus concurrent systemic gemcitabine (1000 mg/m2) followed by systemic 3 cycles of gemcitabine or 4 cycles of S-1. Patients were divided into two groups. The patients who completed planned adjuvant chemotherapy of HAI were classified as the completion group (HAI), and the patients who failed to complete HAI or received systemic adjuvant chemotherapy other than HAI were classified as the control group. Results: One hundred thirty-eight patients (55%) completed planned adjuvant chemotherapy of HAI. On the other hand, 28 patients (11%) failed to complete HAI and 85 patients (34%) received systemic adjuvant chemotherapy alone. The reasons for incompletion of HAI were as follows: any recurrence during HAI treatment in 8, poor general condition of patients in 4, hepatic arterial stenosis in 4 and catheter trouble in 3. Initial hepatic metastasis rate was significantly lower in the HAI group than the control group (15.2 vs. 26.3%, p=0.029), and liver metastasis free survival was significantly better in the HAI group than the control group (p=0.001). The HAI group had a better prognosis than the control group (58.1 vs. 26.9M, p &lt; 0.001). Prognostic factor analysis indicated that failure to complete HAI (p &lt; 0.001, HR 1.95), borderline resectable tumor (p = 0.028, HR 1.63), and lymph node metastasis (p = 0.018, HR 1.59) were the independent adverse prognostic factors. Conclusions: Our data demonstrate that HAI can significantly prevent hepatic recurrence and also improve the postoperative prognosis in pancreatic cancer.