Regional Intra-arterial Infusion Chemotherapy Research Articles

Endovascular implantation of iodine-125 seed strand combined and stent placement for locally advanced pancreatic ductal adenocarcinoma with vascular invasion: a prospective single-arm pilot study.

PurposeTo investigate the safety and feasibility of endovascular brachytherapy using iodine-125 (125I) seed strand for locally advanced pancreatic ductal adenocarcinoma (PDAC) with vascular invasion.Material and methodsFrom January 2010 to January 2015, 12 patients diagnosed with locally advanced, inoperable PDAC with splenic or superior mesenteric vein invasion were enrolled in the present study and received endovascular brachytherapy combined with regional intra-arterial infusion chemotherapy. Standardized software was used for dose calculation. Procedure-related and radiation complications were documented and assessed. Overall survival was calculated with the Kaplan-Meier approach.ResultsThe technical success rate of 125I seed strand implantation and stent placement was 100%. During follow-up with a mean duration of 17.00 ±6.07 months (range, 6~24 months), the mean and median survival times were 12.0 ±2.4 months (95% CI: 7.4~16.6 months) and 10.7 ±1.4 months (95% CI: 8.0~13.5 months), respectively. One month after the treatment, the disease control and objective rates were 83.8% and 58.3%, respectively. The 6-, 12-, and 15-month cumulative survival rates were 66.7%, 47.6%, and 9.5%, respectively.ConclusionsEndovascular brachytherapy using 125I seed strand and stent placement may be a safe and effective treatment option for locally advanced pancreatic duct adenocarcinoma with vascular invasion.

Improved Survival in Patients with Resected Pancreatic Carcinoma Using Postoperative Intensity-Modulated Radiotherapy and Regional Intra-Arterial Infusion Chemotherapy.

BackgroundWe assessed the role of adjuvant intensity-modulated radiotherapy (IMRT) in combination with chemotherapy for pancreatic carcinomas after curative resection and identified prognostic factors related to pancreatic carcinoma after multidisciplinary treatment strategies.Material/MethodsPancreatic carcinoma patients (n=61) who received adjuvant radiotherapy after resection (median dose, 50.4 Gy) between 2010 and 2016 were retrospectively identified. Sixty patients received chemotherapy, including concurrent chemoradiotherapy (CCRT), systemic chemotherapy, and regional intra-arterial infusion chemotherapy (RIAC). The Kaplan-Meier method was used to measure the 3-year overall survival (OS) and disease-free survival (DFS) rates. Log-rank univariate analysis and multivariate Cox regression model analysis were used to identify prognostic factors.ResultsMedian follow-up time was 25.5 (range, 4.9–59.7) months. The 3-year OS and DFS rates were 31.0% and 16.1%, respectively. The median OS and DFS were 27.4 and 16.7 months, respectively. Multivariate analysis indicated that independent favorable predictors for OS were CCRT (p=0.039) and postoperative RIAC (p=0.044). Moreover, postoperative RIAC (p=0.027), and pre-radiotherapy CA19-9 ≤37 U/mL (p=0.0080) were independent favorable predictors for DFS. The combination of radiotherapy and chemotherapy was tolerated well by the patients, and no treatment-related death occurred.ConclusionsCombined IMRT and adjuvant chemotherapy appeared safe and effective for pancreatic carcinoma. CCRT was associated with improved survival with acceptable toxicity. We propose that radiotherapy could be a part of postoperative treatment, but it should be administered concurrently with chemotherapy. Adding RIAC was associated with improved OS and DFS and it could be integrated into the postoperative treatment regimen.

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。

Continuous intra-arterial infusion chemotherapy as a palliative treatment for oral squamous cell carcinoma in octogenarian or older patients

We intend to determine the potential benefits and analyze the outcomes of regional intra-arterial infusion chemotherapy (IAIC) for the octogenarian and older patients with oral cancer. Eighteen patients with oral squamous cell carcinoma were included. They were 12 males and six females with ages ranging from 80 to 96 years. An implantable port-catheter system was used for catheterization. Using a portable pump, methotrexate was given continuously through the external carotid artery for a mean period of 5.5 days (range, 4-7 days) followed by weekly bolus of low dose (25mg) of methotrexate until the clinical condition was stabilized. During the first week of IAIC, all tumors began to reduce in size. Of them 11 (61%) had a complete clinical response and 7 (39%) achieved a partial clinical response, after a mean follow-up period of 26 months (range, 8-72 months). The one- and three-year survival rates were 87% and 56%, respectively. There were no catheter-related complications. The side effects were mild and tolerable. IAIC might be specially indicated for oral cancer elderly with co-morbidity since a radical surgery or extensive radiotherapy can be avoided, and offers an acceptable palliative treatment in such patients.

Distribution and slow-release characters of gemcitabine-loaded bovine serum albumin nanospheres in SD rats

Objective To detect safety,slow-release characters and targeting effects of two kinds of gemcitabine(GEM)-loaded bovine serum albumin nanospheres(mean particle diameters were 110 and 406 nm respectively)through tissue distribution in SD rats.Methods Thirty male SD rates were divided into 3 groups:(1)GEM group(n = 10);(2)110 nm GEM nanospheres group(n = 10);(3)406 nm GEM nanospheres group(n = 10).Pure GEM was used as the model drug,and SD rats as experimental model animal.The concentrations of GEM in blood plasma and various organs of SD rats were dynamically detected by high performance liquid chromatography(HPLC).Results Blood plasma GEM-time curve in GEM group was higher than the other two groups(P ＜ 0.05).The concentrations of GEM in targeting organs,including pancreas(155.59 μg/g),liver(43.57 μg/g)and spleen(35.27 μg/g),were significantly higher in 406 nm nanospheres group than the other two groups 6 h after administration,but those of GEM in heart(116.26 μg/g),lung(8.32 μg/g),kidney(92.10 μg/g),and muscles(81.58 μg/g)were similar to the other 2 groups(P ＞0.05).Conclusion 406 nm GEM-loaded serum albumin nanospheres had excellent targeting effect,slow-release character and safety,and could be applied to the treatment of pancreatic cancer by regional intra-arterial infusion chemotherapy. Key words: Gemcitabine; Nanoparticle; Albumin; Pancreatic carcinoma

Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma.

Regional intra-arterial infusion chemotherapy (RIAC) has been more valuable to improve prognosis and quality of life of patients with inoperable pancreatic adenocarcinomas, and adjuvant RIAC plays an important role in prolonging survival and reducing risk of liver metastasis after radical resection of pancreatic cancer, but the effect of preoperative or multiple-phase RIAC (preoperative combined with postoperative RIAC) for resectable pancreatic cancers has not been investigated. In this prospective study, the effect of multiple-phase RIAC for patients with resectable pancreatic head adenocarcinoma was evaluated, and its safety and validity comparing with postoperative RIAC were also assessed. Patients with resectable pancreatic head cancer were randomly assigned to two groups. Patients in group A (n=50) were treated with new therapeutic mode of extended pancreaticoduodenectomy combined with multiple-phase RIAC, and those in group B (n=50) were treated with extended pancreaticoduodenectomy combined with postoperative RIAC in the same period. The feasibility, compliance and efficiency of the new therapeutic mode were evaluated by tumor size, serum tumor markers, clinical benefit response (CBR), surgical complications, mortality and toxicity of RIAC. The disease-free survival time, median survival time, incidence of liver metastasis, survival rate at 1, 2, 3 and 5 years were also observed. Life curves were generated by the Kaplan-Meier method. The pain relief rate and CBR in group A was 80% and 84% respectively. Serum tumor markers decreased obviously and tumors size decreased in 26% of patients after preoperative RIAC in group A. No more surgical complications, mortality or severe systemic side effects were observed in group A compared with group B. The incidence of liver metastasis in group A was 34% which was lower than 50% in group B. The disease-free survival time and median survival time in group A were 15.5 months and 18 months respectively. The 1-, 2-, 3- and 5-year survival rates were 54.87%, 34.94%, 24.51% and 12.25% respectively. There was no significant difference of survival time or survival rates between two groups. Multiple-phase RIAC is effective in combined therapy of resectable pancreatic head carcinomas by enhancing inhibition of tumor growth and reduction of liver metastasis, without negative effect on patients' safety or surgical procedure.

上顎歯肉扁平上皮癌４９例の臨床的検討

A clinicopathological study was made of 49 patients with squamous cell carcinoma of the upper gingiva between 1980 and 2002, and the following findings were obtained.1) The initial therapy was surgery in 45 patients (34 with an intraoral approach and 11 with an extraoral approach), trimodal combination therapy (external irradiation, per-gingival maxillary sinus surgery, and regional intra-arterial infusion chemotherapy) in 3, and radiotherapy alone in 1. Local cure was obtained in 46 (93.4%) of the 49 patients.2) Twelve patients (40.8%) had histologically confirmed cervical lymph node metastasis. The most frequent site of metastasis was level II of the neck, especially in patients who had posterior invading cancer.3) The overall 5-year cumulative survival rate was 74.6%. Three patients died of local failure, 4 of neck failure, 3 of Rouviere lymph node metastasis, and 4 of distant metastasis.4) Patients with lymph node metastasis in the level II of the neck, contralateralneck metastasis, or Rouviere lymph node metastasis had extremely poor outcomes.5) Rouviere lymph node metastasis should be taken into consideration in patients who have posterior invading cancer and lymph node metastasis in level II of the neck.

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.

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.

Treatment of Maxillary Sinus Carcinoma: Five-Year Results

Previous treatment methods for maxillary sinus carcinoma generally consisted of dissection of maxilla, full dose irradiation, and/or extensive chemotherapy. However, results of such treatment were often poor. Even if patients recover, quality of life (QOL) is significantly reduced as a result of loss of facial structures and functional disability. A retrospective analysis of 42 patients with maxillary sinus carcinoma between 1975 and 1991 was undertaken. All patients underwent pergingival maxillary sinus surgery combined with a standardized total course of pre and postoperative irradiation of 1,600 cGy, together with regional intra-arterial infusion chemotherapy. During the surgery, all visible tumor tissue was removed, and the surrounding tissues were left when possible to facilitate cellular immunity after the surgery. The 5-year survival rate statistically obtained was 100% in Stage II, 100% in Stage III, and 62% in Stage IV patients.

Combination Chemotherapy of Advanced Squamous Carcinoma of the Head and Neck

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

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

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

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

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