Preoperative Intra-arterial Infusion Research Articles

Results of complex treatment of patients with operable pancreatic head cancer using preoperative intra-arterial chemotherapy in combination with radiation therapy in multifractionation mode

The aim of this study was to assess the safety and efficacy of treating patients with operable pancreatic cancer after preoperative intra-arterial infusion of chemotherapy combined with conformal radiation therapy in a multi-fractionation mode. Patients (n = 40) were randomized into two groups: the main one – intra-arterial infusion of chemotherapy + radiation therapy + surgery (n = 20), and control – intra-arterial infusion of chemotherapy + surgery (n = 20). Neoadjuvant therapy consisted of intra-arterial infusion of chemotherapy (chemoembolization of a pancreatic head tumor with oxaliplatin 85 mg/m2) followed by intra-arterial chemo infusion with gemcitabine 1000 mg/m2. In the main group, radiation therapy was also carried out in two fractions per day, 2 Gy with an interval of 4–6 hours, 5 days a week, up to a total dose of 50 Gy. In the main group, the lower incidence of postoperative pancreatitis and the pancreatic fistulas were statistically confirmed, the incidence of grade 2 therapeutic pathomorphisis increased, as well as the median life expectancy.

The impact of combined preoperative and postoperative regional intra-arterial infusion chemotherapy on the survival of low rectal cancer

直肠癌术后复发和转移制约着根治性切除后患者5年生存率的提高.术前区域动脉灌注化疗可提高进展期直肠癌的根治性切除率[1],术后区域动脉灌注化疗可抑制直肠癌根治性切除后盆腔局部复发和肝转移[2].笔者通过对术前辅助肠系膜下动脉及肝动脉灌注化疗、术后辅助双侧髂内动脉及肝动脉灌注化疗加常规静脉化疗的pT3-4N0-2M0期中低位直肠癌患者临床资料的回顾性分析,探讨手术前后联合区域动脉灌注化疗对直肠癌患者复发和远期生存的影响。

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

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

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

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

Analysis of the curative effect of preoperative intra-arterial infusion chemoembolization on stage IB2-IIB uterine cervix cancer

Objective To investigate the short-term and long-term therapeutic efficacy of preoperative intra-arterial infusion chemoembolization on stage IB2-IIB uterine cervix cancer (UCC).

Pre-operative superselective intra-arterial infusion therapy with docetaxel and cisplatin for tongue cancer patients: First results of a phase II study

Pre-operative superselective intra-arterial infusion therapy with docetaxel and cisplatin for tongue cancer patients: First results of a phase II study

Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer.

Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer. Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis. The 5-year survival rate was 52.5% and 39.8%, respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intra-arterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer. Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.

A comparison of methods of loco-regional chemotherapy combined with systemic chemotherapy as neo-adjuvant treatment of osteosarcoma of the extremity

Aim Our experience of pre-operative intraarterial (i.a.) vs intravenous (i.v.) infusion of cisplatinum (CDP) in a multiagent neo-adjuvant chemotherapy for osteosarcoma of the extremity is reported.Methods Two successive randomized studies were performed. In the first, pre-operatively, CDP i.a. vs CDP i.v. was applied in combination with high-dose methotrexate (HDMTX) and adriamycin (ADM) within a three-drug regimen. In the second, a combination of HDMTX, ADM and IFO, within a four-drug regimen was tested. Results The rate of responses to chemotherapy (tumour necrosis ≥90%) was significantly higher (P<0.04) for the 142 patients treated with the four-drug regimen than in the 79 patients treated with a three-drug regimen (76%vs 62%). According to the route of CDP infusion, in the three-drug regimen the rate of responses was significantly higher (P=0.004) in patients treated with i.a. CDP (77%) than in patients treated i.v. (46%); with the four-drug regimen the rate of response was not significantly different in patients treated i.a. (81%) and in patients treated i.v. (71%). No significant differences in the rates of limb salvages, local recurrence and event-free survival (EFS) were seen between the i.a. and the i.v. groups.Conclusion In the treatment of osteosarcoma of the extremity, the i.a. infusion of CDP does not offer any significant advantage when this drug is used within an aggressive, multiagent, pre-operative four-drug regimen.

鼻副鼻腔腺様嚢胞癌に対する集学療法

On 20 patients who had adenoid cystic carcinoma of the nose and paranasal sinuses, the effects of difference of therapeutic modalities on the prognosis of the patients and the effects of preoperative fast neutron irradiation and intraarterial infusion of cisplatin microcapsule (CDDP m. c) on histopathological changes of the tumors were evaluated. Out of 13 patients for whom more than 5 years had elapsed after initial therapy, local recurrences and distant metastases without local recurrence were observed in 2 and 3 patients respectively. In the two patients with T1-2N0 carcinoma of the nasal cavities on whom en bloc resection could be performed easily and securely could survive free of cancer for more than 5 years after surgery alone. Both of the two patients who had operative procedures within the tumor developed distant metastases. Significant clinical and histopathological effect could not be induced by preoperative intraarterial infusion of CDDP m. c. (40-100 mg) and distant metastasis developed in one out of 3 patients. In 6 patients on whom the total dosis (TDF) of preoperative fast neutron irradiation was 100-120, histopathological effects were grade M in 3, grade II b in 2 and grade II a in one patient, classified according to Shimosato's criteria. However, in 5 patients on whom total dosis (TDF) of fast neutron irradiation was 60-80, histopathological effects were confined to grade M in one patient, grade II b in another and grade II a in 3 patients. One patient on whom irradiation effect was grade Ill, treated by irradiation alone, showed recurrence after one year. Although the present study could not clarify the effect of postoperative fast neutron irradiation on the residual tumor, the data suggested the sufficient inhibition effect of full dosis preoperative fast neutron irradiation on occurrence of distant metastasis which may be induced by the operative procedure.

A effective combination preoperative intraarterial infusion chemotherapy and irradiation for advanced sigmoid colon cancer with bladder invasion

A effective combination preoperative intraarterial infusion chemotherapy and irradiation for advanced sigmoid colon cancer with bladder invasion

A CASE OF BREAST CANCER ASSOCIATED WITH ACANTHOSIS NIGRICANS

A rare case of breast cancer associated with acanthosis nigricans is reported. A 59-year-old female was admitted to our hospital with the chief complaints of progressive hyperpigmentation and a huge breast lump. From physical and laboratory findings, these skin and breast lesions were considered to be malignant acanthosis nigricans and advanced breast cancer (T4bN2M1c/Stage IV), respectively. The patient was treated with preoperative intra-arterial infusion chemotherapy followed by surgery, and then chemo-endcrine therapy. The patient has been alive for a follow up period of 6 months, and the skin lesions show remarkable remission under the sustained chemoendocrine therapy. During all these clinical courses, any other malignancies are not confirmed.

Preoperative Intra-Arterial Infusion Chemotherapy for Patients with Bladder Cancer

The effectiveness of the preoperative intra-arterial infusion chemotherapy was studied in 27 patients with muscular invasive bladder cancer. Severe histological destruction of tumor structures was found in 7 cases in the removed bladder at surgery. For these cases, 3-year and 5-year survival rates were 100%. On the other hand, for cases whose destruction of tumor structures was of mild degree or less, 3-year survival rates were 51.9-57.1%. No serious side effect was observed. This preoperative therapy was thought to offer advantages for some patients with muscular invasive bladder cancer.

The follow up study of intra-arterial infusion chemotherapy with local vein blocking as a surgical neo-adjuvant treatment for locally advanced breast cancer.

Preoperative intra-arterial infusion neo-adjuvant chemotherapy, in combination with local vein blocking, was administered to thirty-one patients with locally advanced stage III breast cancer. The anti-cancer drugs and dosages used were 500 mg of 5-Fluorouracil (5FU), which was infused daily for 7-14 days, and 20 mg of Adriamycin (ADM), which was administered as a bolus dose twice into the subclavian and internal mammary arteries. The response rate of this method on the primary tumor was 48.4 per cent, and, histologically it was found to be as high as 90.3 per cent. The response rate of the clinical effects on the regional lymph nodes was 50.0 per cent, however, histologically, it was found to be lower than that of the primary tumor. In the long-term follow-up study the 5-year survival rate was 72.2 per cent. Thus, this method seems to be effective as a combined modality in cases of locally advanced stage III breast cancer.

Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx

Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx

Management of osteogenic sarcoma patients.

The experience in the management of 246 patients with local osteogenic sarcoma and 67 patients with pulmonary metastases in the All-Union Oncologic Research Center, AMS USSR, is presented here. All the patients underwent surgery, but starting in 1974, various modalities of adjuvant chemotherapy (not randomized) were applied in addition. In the surgery alone group, prognosis was very poor: only 7.0% of patients survived free of disease 5 years from the primary tumor treatment. Adjuvant chemotherapy (adriamycin + vincristine + melphalan + cyclophosphamide) following amputations increased this rate to 34.0%; combining segmental resections of an affected bone with preoperative intraarterial adriamycin infusion and radiation (36 Gy) increased the rate to 35.5%. In patients with grade 4 tumor damage (tumor cells are not found upon examination of a large number of sections), the rate increased to 57.9% (P less than .05). Another regimen of adjuvant chemotherapy (platidiam or cisplatin + adriamycin + cyclophosphamide) gives a chance to 78.8% of patients to survive 1 year free of metastases. The same chemotherapy regimen enables us to achieve an objective effect in 30.8% of patients with pulmonary metastases, and its combination with surgical metastasis ablation makes it possible to obtain a complete remission, lasting from 2 to 46 months (average 13.9 months). Toxic manifestations of the chemotherapy regimens considered are moderate. Prognosis in adjuvant chemotherapy is related to age, tumor site, its local dissemination, and morphologic type of osteogenic sarcoma.

Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx.

Twelve patients with advanced locoregional (Stage III and IV) squamous cell carcinoma of the oral cavity and oropharynx underwent treatment with cisplatin, vinblastine, bleomycin, and 5-fluorouracil, given by intra-arterial infusion, as primary adjuvant therapy, in preparation for radiation therapy and surgery. Responses were observed during or immediately after infusion therapy in 8 of 12 (67%) of patients (1 complete response, 7 partial responses). Infusion chemotherapy was followed by radiation therapy alone in five patients and by radiation and surgery in six patients. The protocol was initiated in August 1981, and six patients are now free of their primary cancer, at 21 to 36 months, whereas six have died with disease. Arterial infusion of a combination of effective antineoplastic agents is a promising method for the preparation of selected patients for radiation therapy and surgery, as it is less likely to produce serious systemic toxicity and it requires a shorter period than systemic neoadjuvant chemotherapy.

Treatment of Osteosarcoma

41 cases of osteosarcoma were treated in our department in 2 decades from 1960 to 1979.The surgical treatment and radiation therapy were primarily used in 8 case detected in 5 years from 1960 to 1964, the chemotherapy being applied in combination. The results were poor, the 5-year survival rate being only 12.5%.25 cases were treated in 10 years from 1965 to 1974. Only 10 of them were subjected to the pre-operative intra-arterial infusion. The 5-year survival rate was 40% and 26% for these 10 cases and the rest 15 cases who had not undergone any pre-operative intra-arterial infusion, showing a favorable effect of pre-operative intra-arterial infusion.8 cases were treated in 5 years from 1975 to 1979, 7 of them being subjected to the pre-operative intra-arterial infusion. The multi-drug chemotherapy was used in these 8 cases, who made favorable progress.Our latest therapeutic approach lays main emphasis on the pre- and post-operative chemotherapy. Namely, patients are hospitalized in short duration at intervals for chemotherapy while they are examined in the outpatient clinic for progress when they are released from the hospital. If any sign of pulmonary metastasis is detected, the patient is strongly persuaded to undergo the lobectomy.

A study of survival in patients with stomach cancer treated by a combination of preoperative intra-arterial infusion therapy and surgery.

Since 1968, there have been 62 patients with stomach cancer seen in the First Department of Surgery of Chiba University. Treatment consisted of preoperative intra-arterial chemotherapy and surgery. The chemotherapy entailed continuous infusion for 15 to 20 hours. The survival rates were analyzed with particular emphasis on the degree of serosal invasion of the stomach. The overall survivals at the end of 3 years were 54.2% for the treated patients, and 37.1% for the controls: and at the end of 5 years, 33.3% of the treated patients were living as compared to 29.7% of the control patients. In patients without serosal invasion, the survival rates were higher for those treated than for the controls for the first 2 years. At the end of 3 years, the 39 patients treated for serosal invasion had a survival rate of 46.8% vs. 29% in the controls: and at 5 years, 32.2% of the treated patients vs. 23.7% in the controls. The survival rates for the treated patients with cancerous infiltration of other organs were about the same as those for the corresponding control patients.

Studies on preoperative cancer chemotherapy. Methods of preoperative intra-arterial infusion by the use of methotrexate or vinblastine.

For the purpose of performing combined therapy with surgery and preoperative intra-arterial infusion of methotrexate or vinblastine, polyethylene catheters were inserted into the right gastroepiploic artery of 18 patients with gastric cancer, through a small midline incision in the epigastrium. The best positioning of the catheter was decided by infusion of Evans blue. The dose schedules were approximately as follows: 1. methotrexate group: 33 mg of methotrexate were continuously infused 3 times within 36 hours before gastrectomy and 15 mg of leucovorin intramuscularly at one hour after each infusion; 2. vinblastine group: 6 mg of vinblastine were administered twice within 24 hours before gastrectomy and its 3 antidotes intravenously within one hour after the start of each infusion. Pathologic examination after surgery showed prevention of DNA biosynthesis and irreversible changes of chromosomes in cancer cells. The preoperative infusion of the drugs was accompanied by little complication in the postoperative course after gastrectomy.

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