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Fayzullin A, Bakulina A, Mikaelyan K, Shekhter A, Guller A. Implantable Drug Delivery Systems and Foreign Body Reaction: Traversing the Current Clinical Landscape. Bioengineering (Basel) 2021; 8:bioengineering8120205. [PMID: 34940358 PMCID: PMC8698517 DOI: 10.3390/bioengineering8120205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Precise delivery of therapeutics to the target structures is essential for treatment efficiency and safety. Drug administration via conventional routes requires overcoming multiple transport barriers to achieve and maintain the local drug concentration and commonly results in unwanted off-target effects. Patients’ compliance with the treatment schedule remains another challenge. Implantable drug delivery systems (IDDSs) provide a way to solve these problems. IDDSs are bioengineering devices surgically placed inside the patient’s tissues to avoid first-pass metabolism and reduce the systemic toxicity of the drug by eluting the therapeutic payload in the vicinity of the target tissues. IDDSs present an impressive example of successful translation of the research and engineering findings to the patient’s bedside. It is envisaged that the IDDS technologies will grow exponentially in the coming years. However, to pave the way for this progress, it is essential to learn lessons from the past and present of IDDSs clinical applications. The efficiency and safety of the drug-eluting implants depend on the interactions between the device and the hosting tissues. In this review, we address this need and analyze the clinical landscape of the FDA-approved IDDSs applications in the context of the foreign body reaction, a key aspect of implant–tissue integration.
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Affiliation(s)
- Alexey Fayzullin
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Alesia Bakulina
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
| | - Karen Mikaelyan
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Anatoly Shekhter
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
| | - Anna Guller
- Department of Experimental Morphology and Biobanking, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.F.); (A.B.); (K.M.); (A.S.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Biomolecular Discovery Research Centre, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
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Rahman H, Hossain MR, Ferdous T. The recent advancement of low-dimensional nanostructured materials for drug delivery and drug sensing application: A brief review. J Mol Liq 2020; 320:114427. [PMID: 33012931 PMCID: PMC7525470 DOI: 10.1016/j.molliq.2020.114427] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 01/07/2023]
Abstract
In this review article, we have presented a detailed analysis of the recent advancement of quantum mechanical calculations in the applications of the low-dimensional nanomaterials (LDNs) into biomedical fields like biosensors and drug delivery systems development. Biosensors play an essential role for many communities, e.g. law enforcing agencies to sense illicit drugs, medical communities to remove overdosed medications from the human and animal body etc. Besides, drug delivery systems are theoretically being proposed for many years and experimentally found to deliver the drug to the targeted sites by reducing the harmful side effects significantly. In current COVID-19 pandemic, biosensors can play significant roles, e.g. to remove experimental drugs during the human trials if they show any unwanted adverse effect etc. where the drug delivery systems can be potentially applied to reduce the side effects. But before proceeding to these noble and expensive translational research works, advanced theoretical calculations can provide the possible outcomes with considerable accuracy. Hence in this review article, we have analyzed how theoretical calculations can be used to investigate LDNs as potential biosensor devices or drug delivery systems. We have also made a very brief discussion on the properties of biosensors or drug delivery systems which should be investigated for the biomedical applications and how to calculate them theoretically. Finally, we have made a detailed analysis of a large number of recently published research works where theoretical calculations were used to propose different LDNs for bio-sensing and drug delivery applications.
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Affiliation(s)
- Hamidur Rahman
- Department of Physics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Md Rakib Hossain
- Department of Physics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
| | - Tahmina Ferdous
- Department of Physics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
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Kobayashi S, Kozaka K, Gabata T, Matsui O, Koda W, Okuda M, Okumura K, Sugiura T, Ogi T. Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors. Cancers (Basel) 2020; 12:cancers12092596. [PMID: 32932894 PMCID: PMC7565329 DOI: 10.3390/cancers12092596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Bile duct necrosis (BDN) is rare but serious complication of transarterial therapy for liver tumors. During development of BDN, ischemia of the peribiliary vascular plexus (PBP) induces the disruption of the bile duct epithelial protection mechanism, causing necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN starts, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On CT images, BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Clinicians should be aware that although BDN and biloma can usually be treated conservatively, in the presence of symptoms such as moderate or severe infection or interval growth of the biloma, prompt treatment is essential to avoid lethal abscess formation and sepsis. Abstract Bile duct necrosis (BDN) with biloma formation is a type of ischemic bile duct injury that is one of the serious complications associated with transarterial therapies, such as transcatheter chemoembolization therapy (TACE), and radioembolization for hepatocellular carcinoma (HCC) and hepatic arterial infusion chemotherapy (HAIC) for metastatic liver cancer from colorectal carcinoma. In terms of the occurrence of BDN and subsequent biloma formation, ischemic injury to the peribiliary vascular plexus (PBP), the supporting vessel of bile duct epithelium, is thought to be intimately associated. In this paper, we first describe the anatomy, blood supply, and function of the intrahepatic bile duct, and then illustrate the pathophysiology of BDN, and finally present the imaging findings of BDN. Under the process of BDN formation, ischemia of the PBP induces the disruption of the bile duct epithelial protection mechanism that causes coagulation and fibrinoid necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN occurs, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On pre-contrast and contrast-enhanced computed tomography (CT), BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Differentiation of imaging findings on CT and ultrasound (US)/magnetic resonance (MR) imaging/MR cholangiopancreatography (MRCP) is important for correct diagnosis of BDN.
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Thiels CA, D'Angelica MI. Hepatic artery infusion pumps. J Surg Oncol 2020; 122:70-77. [PMID: 32215927 DOI: 10.1002/jso.25913] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/29/2020] [Indexed: 01/04/2023]
Abstract
The preferential blood supply from the hepatic artery to liver tumors allows for the regional delivery of chemotherapy, commonly referred to as hepatic artery infusion chemotherapy via a subcutaneous pump. Hepatic artery infusion chemotherapy has been demonstrated to improve overall survival in select patients with colorectal liver metastasis and is a promising treatment for unresectable intrahepatic cholangiocarcinoma. This review focuses on the technical aspects of hepatic artery infusion pump placement.
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Affiliation(s)
- Cornelius A Thiels
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Michael I D'Angelica
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
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Durivage HJ, Burnham NL. Prevention and Management of Toxicities Associated With Antineoplastic Drugs. J Pharm Pract 2016. [DOI: 10.1177/089719009100400105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Henry J. Durivage
- Section of Medical Oncology, NSB-294, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510
| | - Nora L. Burnham
- Section of Medical Oncology, NSB-294, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510
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Lee HJ, Lee YS, Lee KW, Kim SY, Yoon CJ, Shin DY, Lee YG, Choi SY, Kang SG, Kang SB, Kim JH. Efficacy and safety of hepatic arterial infusion of fluorouracil with leucovorin as salvage treatment for refractory liver metastases from colorectal cancer. Korean J Intern Med 2011; 26:82-8. [PMID: 21437167 PMCID: PMC3056261 DOI: 10.3904/kjim.2011.26.1.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/06/2010] [Accepted: 10/26/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Limited options remain for patients with metastatic colorectal cancer (CRC) after failure of standard systemic chemotherapy. Readministration of chemotherapeutic agents by hepatic arterial infusion (HAI) has the rationale of providing higher concentrations of chemotherapeutic agents to hepatic metastases. The present study was conducted to evaluate the efficacy and safety of HAI of fluorouracil with leucovorin (HAI 5-FU/LV) for patients with liver metastases from CRC. METHODS Fourteen patients with liver metastases from CRC who received HAI 5-FU/LV after failure of systemic chemotherapy containing fluorouracil and leucovorin were identified and their medical records were reviewed. RESULTS Of 10 patients evaluable for response, one partial response, six stable disease, and three progressive disease were reported. Additionally, the overall response and disease control rates were 7% and 50%, respectively. The median time to progression was 4.3 months (range, 2.9 to 5.6), to hepatic progression was 5.8 months (range, 4.7 to 6.9), and to extrahepatic progression was 5.8 months (range, 2.3 to 9.2). No grade 3/4 hematologic toxicities occurred and one case of abdominal pain and two cases of oral mucositis were the only grade 3 nonhematologic toxicities. Catheter-related complications occurred in three patients: one thrombosis, one infection, and one displacement. CONCLUSIONS HAI 5-FU/LV was well tolerated and showed modest efficacy for patients with liver metastases from refractory CRC. Readministration of previously used chemotherapeutic agents via the hepatic artery could be an effective salvage option and warrants further investigation in a prospective trial.
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Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Soo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So Yeon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Gyoo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Gwon Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Yezhelyev M, Osgood M, Egnatashvili V, Lumsden A, Staley CA, Kooby DA. Saphenous vein graft conduits for insertion of hepatic arterial infusion pumps in patients with abnormal hepatic arterial anatomy. J Surg Oncol 2007; 97:85-9. [PMID: 17786960 DOI: 10.1002/jso.20890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Hepatic arterial infusion (HAI) chemotherapy offers improved hepatic control for liver metastases from colon cancer. Optimal catheter insertion requires an adequate gastroduodenal artery (GDA). Limited data exists on using saphenous vein grafts (SVG) as conduits when native vasculature is inadequate. METHODS All HAI pump insertions from 7/99 to 7/03 requiring SVG conduits (N = 10) were analyzed for arterial anatomy, operative conduct, and outcome. RESULTS From 1988 through 2005, 124 HAI pumps were placed of which 10 received SVG conduits to optimize placement. Mean operative time was 251 +/- 50 min and mean blood loss was 230 +/- 30 cm(3). All were placed with palliative intent. Three patients (30%) had type 1 anatomy with inadequate GDA. Five (50%) had type 3 anatomy with replaced right hepatic artery, one (10%) had a small GDA originating off the right hepatic artery, and one patient (10%) had a trifurcation. Two (20%) pump-related complications were identified, and only one (10%) was related to vasculature (catheter thrombosis as a result of hepatic arterial stenosis distal to the SVG insertion site). CONCLUSIONS Complication rates related to SVG conduits for hepatic arterial infusion pump placement are low. Saphenous vein grafts are acceptable conduits for patients with abnormal hepatic arterial anatomy.
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Affiliation(s)
- Maksym Yezhelyev
- Department of Surgery, Emory University, Atlanta, Georgia 30322, USA
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Phongkitkarun S, Kobayashi S, Varavithya V, Huang X, Curley SA, Charnsangavej C. Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT. Clin Radiol 2005; 60:700-9. [PMID: 16038698 DOI: 10.1016/j.crad.2005.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Revised: 12/21/2004] [Accepted: 01/12/2005] [Indexed: 10/25/2022]
Abstract
AIM To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. METHODS Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data. RESULTS Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. CONCLUSION Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.
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Affiliation(s)
- S Phongkitkarun
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Martín de Carpi J, Tarrado X, Varea V. Sclerosing cholangitis secondary to hepatic artery ligation after abdominal trauma. Eur J Gastroenterol Hepatol 2005; 17:987-90. [PMID: 16093878 DOI: 10.1097/00042737-200509000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several causes have been postulated as responsible for secondary sclerosing cholangitis (SSC), mainly in adults, and, although in very different situations, ischaemia seems to be one of the most important factors. The term 'ischaemic cholangitis' has been used as a collective label for all these ischaemia-induced bile duct lesions. The biliary epithelium is dependent on arterial blood flow, unlike the hepatic parenchyma, which receives a dual blood supply from the hepatic artery and the portal vein. This makes the biliary epithelium very susceptible to changes in arterial blood flow. We present one adolescent patient who developed SSC after abdominal trauma with hepatectomy and ligation of the right hepatic artery. Different factors could have helped in the development of SSC in our patient (septicaemia, bile duct destruction, cholecystectomy) but right hepatic artery ligation seems to be the most important aetiological factor in the development of secondary ischaemic cholangitis.
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Affiliation(s)
- Javier Martín de Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu-Barcelona, Spain.
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Allen PJ, Nissan A, Picon AI, Kemeny N, Dudrick P, Ben-Porat L, Espat J, Stojadinovic A, Cohen AM, Fong Y, Paty PB. Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases. J Am Coll Surg 2005; 201:57-65. [PMID: 15978444 DOI: 10.1016/j.jamcollsurg.2005.03.019] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Revised: 02/07/2005] [Accepted: 03/08/2005] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hepatic arterial infusion pump chemotherapy is an important component in the treatment of patients with hepatic metastases. Successful use of a hepatic arterial infusion pump requires a low technical complication rate. We evaluated the complications and longterm durability of these devices at our institution. STUDY DESIGN Between April 1986 and March 2001, 544 patients underwent hepatic arterial infusion pump placement for treatment of unresectable colorectal liver metastases. Patient- and pump-related data were collected by chart review. Pump-related complications, duration of pump function, and overall patient survival were recorded. RESULTS Median patient survival was 24 months after pump placement. The incidences of pump failure were 9% at 1 year and 16% at 2 years. Pump complications occurred in 120 (22%) of the patients. Complications that occurred early after operation (< 30 days) were more likely to be salvaged than those occurring late (70% versus 30%, p < 0.001). Increased pump complication rates occurred in the setting of variant arterial anatomy (28% versus 19%, p = 0.02), when the catheter was inserted into a vessel other than the gastroduodenal artery (42% versus 21%, p = 0.004), if the pump was placed during the first half of the study period (1986 to 1993, 25% versus 1994 to 2001, 18%; p = 0.05), and if the surgeon had performed fewer than 25 earlier procedures (< 25, 31% versus > or = 25, 19%; p < 0.002). CONCLUSIONS In this large single institution experience, pump-related complications were low, the majority of early pump complications were salvaged, and pump complication rates improved as institutional experience accumulated. Longterm durability of pump function was excellent.
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Affiliation(s)
- Peter J Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY10021, USA
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Whisenant J, Venook A. Regional therapy of liver metastases. Curr Treat Options Oncol 2004; 5:427-37. [PMID: 15341680 DOI: 10.1007/s11864-004-0032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Liver metastases usually represent disseminated cancer; therefore, systemic chemotherapy is always appropriate. However, in some instances, the liver is the only site of metastasis and regional control of liver tumors may have important palliative and survival benefits, including a possibility of cure in selected patients. This review identifies unique patient subgroups that may benefit from regional therapy of liver metastases, and considers different treatment options and when these different options may be indicated.
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Affiliation(s)
- Jonathan Whisenant
- UCSF/Mt. Zion Cancer Center, Medical Oncology, Fourth Floor, Box 1705, 1600 Divisadero, San Francisco, CA 94115, USA
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Barber FD, Mavligit G, Kurzrock R. Hepatic arterial infusion chemotherapy for metastatic colorectal cancer: a concise overview. Cancer Treat Rev 2004; 30:425-36. [PMID: 15245775 DOI: 10.1016/j.ctrv.2004.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with colorectal cancer commonly succumb to the sequelae of hepatic metastases. Response to systemic therapy is inadequate. Hepatic arterial infusion (HAI) exposes liver metastases to high local concentrations of drug. Herein, we review the randomized trials of HAI in colorectal cancer. Data for this review were identified by searches of MEDLINE and references from relevant articles using the search terms "infusion intra-arterial" and "colorectal cancer." Abstracts and reports from meetings were included only when they related directly to previously published work. Only papers published in English between 1966 and 2003 were included. Randomized trials (5-fluorouracil- (5-FU-) or fluordeoxyuridine- (FUDR-) based regimens) often demonstrated superior response rates for HAI as compared to systemic chemotherapy (primary treatment or post-resection). Enhanced survival has, however, shown only when HAI was combined with systemic chemotherapy in the post-resection setting. For 5-FU-based and perhaps other regimens, randomized trials of combined regional and systemic therapy versus systemic treatment alone may be needed in order to determine whether or not there is a survival advantage after HAI in unresectable patients, as has been recently demonstrated in resectable patients. A variety of agents other than 5-FU have also been given by HAI to patients with liver metastases from diverse cancers. Such regional therapy often yields encouraging response rates and impact on survival therefore merits investigation.
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Affiliation(s)
- Fedricker D Barber
- Department of Bioimmunotherapy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 422, Houston, TX 77030, USA
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Venturini M, Angeli E, Salvioni M, De Cobelli F, Ronzoni M, Aldrighetti L, Stella M, Carlucci M, Staudacher C, Di Carlo V, Ferla G, Villa E, Del Maschio A. Complications After Percutaneous Transaxillary Implantation of a Catheter for Intraarterial Chemotherapy of Liver Tumors:Clinical Relevance and Management in 204 Patients. AJR Am J Roentgenol 2004; 182:1417-26. [PMID: 15149985 DOI: 10.2214/ajr.182.6.1821417] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of the study were to evaluate the complications of patients who underwent percutaneous transaxillary implantation of a permanent catheter-port system for intraarterial hepatic chemotherapy and determine their clinical relevance and specific management. SUBJECTS AND METHODS. Catheter-port systems were placed in 204 patients with liver tumors (86.7% from colorectal metastases). Under sonographic and fluoroscopic guidance, a 5.8-French catheter was placed in the hepatic artery and connected to a subcutaneous reservoir after embolization of the gastroduodenal and right gastric arteries. Floxuridine plus dexamethasone and systemic low-dose heparin were administered. During the follow-up period, complications were classified as clinically not significant (type 1), clinically significant not requiring interruption of intrahepatic chemotherapy (type 2), clinically significant needing temporary suppression of intrahepatic chemotherapy (type 3), and clinically significant causing permanent suppression of intrahepatic chemotherapy (type 4). RESULTS No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles was 8.1. The mean follow-up period was 270 days. Primary and secondary patency rates of the system were 71.6% and 91.2%, respectively. Temporary suppression of intrahepatic chemotherapy was necessary in 19.6% of the patients and definitive suppression, in 8.8%. Hepatic artery thrombosis, not recanalized by local thrombolysis, was the main cause of permanent intrahepatic chemotherapy interruption (4.4%). Catheter occlusions and cerebral complications were not observed. In 91.2% of the patients, intrahepatic chemotherapy could be completed. CONCLUSION Percutaneous implantation of a removable and reimplantable catheter-port system for intrahepatic chemotherapy can be a safe procedure to treat unresectable liver metastases from colorectal cancer. Technical and pharmacologic complications with variable clinical relevance occurred, and various specific management strategies were necessary to reduce their incidence.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, Scientific Institute S. Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy
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Heinrich S, Petrowsky H, Schwinnen I, Staib-Sebler E, Gog C, El-Ganainy A, Gutt C, Müller HH, Lorenz M. Technical complications of continuous intra-arterial chemotherapy with 5-fluorodeoxyuridine and 5-fluorouracil for colorectal liver metastases. Surgery 2003; 133:40-8. [PMID: 12563236 DOI: 10.1067/msy.2003.37] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy is an effective modality to treat unresectable hepatic metastases from colorectal primaries if systemic chemotherapy has failed. Response rates of more than 40% and a median survival of 15 to 25 months have been reported from randomized trials. In this retrospective study, we analyzed specific technical complications associated with continuous intra-arterial chemotherapy for colorectal liver metastases. METHODS From 1982 to 1995, single-center clinical data from 180 patients with colorectal liver metastases were evaluated. Continuous intra-arterial chemotherapy was administered using either an implanted infusion pump or an intra-arterial port with an external infusion pump. The intra-arterial catheter was implanted according to the Watkins' technique. The treatment protocols consisted of 5-fluorouracil- or 5-fluorodeoxyuridine-based regimens. RESULTS A total of 70 patients (39%) received an intra-arterial infusion pump and 110 patients (61%) an intra-arterial port. Sixty-eight technical complications affected port systems (62%), whereas 29 patients with pumps (41%) were affected by technical complications. Therapy-relevant complications were observed in 47% of the ports and 30% of the infusion pumps. The median complication-free survival was 12.2 months for infusion pumps and 7.3 months for ports (P =.0016). CONCLUSIONS Our data demonstrate that pumps are superior to ports in terms of complication rate and complication-free survival. On the basis of our results, pumps have a potential for a longer treatment, which may result in a prolonged median survival.
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Affiliation(s)
- Stefan Heinrich
- Department of General and Vascular Surgery, University of Frankfurt Medical Center, Frankfurt, Germany
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Franklin ME, Gonzalez JJ. Laparoscopic placement of hepatic artery catheter for regional chemotherapy infusion: technique, benefits, and complications. Surg Laparosc Endosc Percutan Tech 2002; 12:398-407. [PMID: 12496545 DOI: 10.1097/00129689-200212000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 15% to 18% of patients diagnosed with colorectal cancers present with metastases confined to the liver. Although many may undergo a liver resection procedure, some will not be candidates for surgery or will have recurrence of liver disease within the first 2 years after liver metastasis resection. For this subset of patients, regional hepatic chemotherapy, including intra-arterial chemotherapy, has been shown to improve control of the disease and, in some cases, prolong survival. With the advent of laparoscopic surgery and its application to more and more advanced procedures, the possibility of laparoscopic placement of a chemotherapy infusion catheter in the hepatic artery with all the advantages of a minimally invasive approach appears to be a viable alternative in our hands. From November 1993 through February 2002, 20 patients (12 male, 8 female) successfully underwent laparoscopic placement of a hepatic artery infusion catheter at the Texas Endosurgery Institute. Correct placement of the catheter was confirmed by methylene blue injections via the hepatic artery catheter at the time of surgery. Chemotherapy was generally initiated in the immediate postoperative period. Mean age was 68.3 years (range, 46-82). Twelve of the patients (60%) had previously undergone abdominal surgery. There were 27 major laparoscopic procedures performed at the time of hepatic artery catheter placement. There were no conversions to an open procedure. Mean operative time was 186 minutes (range, 125-280), and mean blood loss was 132 mL (range, 20-300). These values include the 27 major concurrent laparoscopic procedures performed at the time of catheter placement, including 18 cholecystectomies, 7 colectomies, and 2 liver resections. Median hospital stay was 3 days (range, 3-25), with a median return to regular diet of 3 days. There were no intraoperative complications and no deaths secondary to catheter placement. There were 2 late complications, for an overall rate of 10%. For all 17 patients with residual hepatic disease whose chemotherapy was successfully instituted, regression of the metastases was evident by abdominal computed tomographic criteria and CEA levels. Laparoscopic hepatic artery catheterization is both feasible and safe. It incurs all the benefits of a minimally invasive procedure and can be performed at the time of laparoscopic colectomy to avoid the necessity of a second procedure.
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Affiliation(s)
- Morris E Franklin
- Department of Surgery, University Texas Health Care Center at San Antonio, USA.
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Allen PJ, Stojadinovic A, Ben-Porat L, Gonen M, Kooby D, Blumgart L, Paty P, Fong Y. The management of variant arterial anatomy during hepatic arterial infusion pump placement. Ann Surg Oncol 2002; 9:875-80. [PMID: 12417509 DOI: 10.1007/bf02557524] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The success of hepatic arterial infusion pump (HAIP) placement in patients with variant arterial anatomy has not been well described. METHODS Patients who underwent HAIP placement over a 5-year time period were evaluated. Arterial- and catheter-related pump complication rates and pump survival were compared between patients with normal and variant arterial anatomy. RESULTS Pumps were placed in 265 patients. Variant anatomy was present in 98 (37%) patients. The presence of variant versus normal anatomy did not increase pump complication rates (8% vs. 4%; P =.18) or decrease pump survival (P =.12). In all patients with an isolated variant right or left hepatic artery (n = 56), ligation of the variant vessel and cannulation of the gastroduodenal artery (GDA) resulted in complete hepatic perfusion and no pump complications. Cannulation of vessels other than the GDA (n = 22) was associated with increased pump complication rates (27% vs. 4%; P =.0001) and decreased pump survival (P =.002). CONCLUSIONS In this study, HAIP placement in patients with variant anatomy was not associated with increased pump complication rates or decreased pump survival. An optimal strategy for managing variant anatomy is to ligate isolated variant vessels and cannulate the GDA.
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Affiliation(s)
- Peter J Allen
- Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Shrikhande S, Friess H, Kleeff J, Tempia A, Zimmermann A, Borner M, Büchler MW. Bile duct infarction following intraarterial hepatic chemotherapy mimicking multiple liver metastasis: report of a case and review of the literature. Dig Dis Sci 2002; 47:338-44. [PMID: 11855550 DOI: 10.1023/a:1013770005784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Shailesh Shrikhande
- Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland
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Talbot ML, Clark JR, Clingan PC, Morris DL. Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain. HPB (Oxford) 2002; 4:29-34. [PMID: 18333149 PMCID: PMC2023909 DOI: 10.1080/136518202753598708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration. PATIENTS AND METHODS In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography. RESULTS Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.
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Affiliation(s)
- ML Talbot
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - JR Clark
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - PC Clingan
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - DL Morris
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
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Buecher B, Bleiberg H. Review article: non-systemic chemotherapy in the treatment of colorectal cancer-portal vein, hepatic arterial and intraperitoneal approaches. Aliment Pharmacol Ther 2001; 15:1527-41. [PMID: 11563991 DOI: 10.1046/j.1365-2036.2001.01061.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Loco-regional chemotherapy, an alternative to systemic chemotherapy in the management of colorectal cancer, has been evaluated in both adjuvant and palliative settings. The rationale for loco-regional delivery is to achieve higher dose concentrations of drugs at the tumour site or at the most common sites of tumour recurrence, while limiting systemic exposure and associated toxicity. Adjuvant intraportal chemotherapy and palliative hepa-tic arterial chemotherapy have been most extensively investigated. Intraperitoneal chemotherapy has also been studied as an adjuvant treatment after complete resection of colorectal cancer or cytoreductive surgery in patients with established peritoneal carcinomatosis. The results obtained have been disappointing, and none of these procedures can be considered as a standard therapeutic option today. However, methodological difficulties were encountered in most published studies, and the investigated schedules and doses may not have been optimal. New combinations of cytotoxic drugs and new indications are currently under consideration. Promising results have recently been published for adjuvant intraperitoneal chemotherapy and hepatic arterial chemotherapy following surgical resection of hepatic metastases, but additional well-designed multicentre phase III trials are needed to determine the true benefits of these treatment modalities and to address the issues of cost and quality of life.
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Affiliation(s)
- B Buecher
- Department of Gastroenterology, University Hospital, Place Alexis Ricordeau, 44093 Nantes Cedex, France.
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Abstract
The liver is a common site of metastases from cancers from most sites, but particularly from the gastrointestinal tract, since the portal vein drains into the liver. About half of all patients with colorectal cancer develop liver metastases. The response of liver metastases to systemic combination chemotherapy has improved, but the 2-year survival is only 25-30%. Hepatic-arterial infusion of chemotherapy produces higher response rates, with a 2-year survival of 50-60%. In patients who can undergo liver resection followed by hepatic-arterial infusion, the 2-year survival is 85%. This review summarises the anatomical basis, pharmacokinetic background, and cost-effectiveness of this procedure. We discuss the phase II and phase III studies of hepatic-arterial infusion therapy, with a focus on liver metastases from colorectal cancer.
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Affiliation(s)
- N Kemeny
- Memorial Sloan-Kettering Cancer Center, Gastrointestinal Oncology Service, New York, NY 10021, USA.
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Reguart N, Maurel J, Gascón P. [Complementary and alternative treatment to surgery in liver metastases of colorectal cancer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:210-7. [PMID: 11333661 DOI: 10.1016/s0210-5705(01)70152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- N Reguart
- Servicio de Oncología Médica. Hospital Clínic Universitari de Barcelona, Spain
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van Riel JM, van Groeningen CJ, Albers SH, Cazemier M, Meijer S, Bleichrodt R, van den Berg FG, Pinedo HM, Giaccone G. Hepatic arterial 5-fluorouracil in patients with liver metastases of colorectal cancer: single-centre experience in 145 patients. Ann Oncol 2000; 11:1563-70. [PMID: 11205464 DOI: 10.1023/a:1008369520179] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic arterial chemotherapy for liver metastases of colorectal cancer is still under discussion. Mainly because of the technical complications of this mode of treatment and the lack of a survival benefit in randomized studies. We performed an analysis of hepatic arterial 5-fluorouracil (5-FU) chemotherapy in 145 consecutive patients treated at a single institution. PATIENTS AND METHODS One hundred forty-five patients with inoperable liver metastases from colorectal cancer were included. 5-FU, 1000 mg/m2/day continuous infusion for five days every three weeks, was delivered in the hepatic artery by percutaneous catheter or arterial access device. RESULTS The response rate was 34% for all patients, 40% in patients with extrahepatic disease, and 15% in patients with i.v. 5-FU-based pretreatment. TTP and OS for all patients were 7.5 and 14.3 months, respectively. In patients with extrahepatic disease or i.v. 5-FU-based pretreatment, OS was significantly shorter compared to patients without extrahepatic disease or 5-FU-based pretreatment (9.7 vs. 19.3 months and 10.1 vs. 17.4 months, respectively), forty-seven percent of patients stopped treatment because of a complication. Complications most often seen in patients with arterial ports were hepatic artery thrombosis (48%) and dislocation of the catheter (22%). CONCLUSIONS The results of our analysis are in line with previous phase III studies. Extrahepatic disease and i.v. 5-FU-based pretreatment were prognostic for reduced OS. The complication rate of hepatic arterial delivery was worrisome. although, no negative impact on survival could be established. There is a strong need for improvement of hepatic arterial delivery methods before further evaluation of hepatic arterial
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Affiliation(s)
- J M van Riel
- Department of Medical Oncology, University Hospital Vrije Universiteit Amsterdam, The Netherlands.
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Dutcher JP, Novik Y, O'Boyle K, Marcoullis G, Secco C, Wiernik PH. 20th-century advances in drug therapy in oncology--Part I. J Clin Pharmacol 2000; 40:1007-24. [PMID: 10975071 DOI: 10.1177/00912700022009620] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J P Dutcher
- Our Lady of Mercy Cancer Center, New York Medical College, Bronx 10466, USA
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Allen-Mersh TG, Glover C, Fordy C, Mathur P, Quinn H. Randomized trial of regional plus systemic fluorinated pyrimidine compared with systemic fluorinated pyrimidine in treatment of colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:468-73. [PMID: 11016468 DOI: 10.1053/ejso.1999.0924] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM We report a prospective randomized study comparing survival, response and toxicity in colorectal liver metastasis (CLM) patients treated by either hepatic arterial floxuridine (HAI) plus continuous systemic fluorouracil/folinic acid or systemic fluorouracil/folinic acid. METHODS Eighty-four CLM patients received either HAI plus systemic fluorouracil/folinic acid or systemic fluorouracil/ folinic acid. RESULTS Significantly more HAI plus systemic, compared with systemic only, patients developed WHO grade 3 or 4 diarrhoea (P=0.004), but significant quality of life differences were not detected. Liver metastasis partial response at 4 months after randomization was significantly greater (P=0.003) in HAI plus systemic (13/29, 45%) compared with systemic only (7/30, 23%) patients. There was no significant difference between groups in the proportion of patients who died from extrahepatic disease progression, or in survival. CONCLUSION Combining regional with systemic fluorinated pyrimidines did not improve survival compared with systemic fluorinated pyrimidine.
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Affiliation(s)
- T G Allen-Mersh
- Department of Surgical Oncology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK.
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Herrmann KA, Waggershauser T, Sittek H, Reiser MF. Liver intraarterial chemotherapy: use of the femoral artery for percutaneous implantation of catheter-port systems. Radiology 2000; 215:294-9. [PMID: 10751501 DOI: 10.1148/radiology.215.1.r00ap14294] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To provide intraarterial chemotherapy of the liver in 30 outpatients with colorectal cancer metastases and other malignancies, 32 catheter-port systems were implanted percutaneously via the femoral artery. Mean patency was 229 days. Percutaneous placement was feasible and safe. Compared with surgical placement, the overall complication rate (12%) was comparable or less.
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Affiliation(s)
- K A Herrmann
- Institute of Clinical Radiology, Ludwig-Maximilians-University of Munich, Grosshadern Marchioninistr 15, D-81377 Munich, Germany.
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Lorenz M, Müller HH. Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 2000; 18:243-54. [PMID: 10637236 DOI: 10.1200/jco.2000.18.2.243] [Citation(s) in RCA: 253] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the efficacy and tolerability of three treatments for patients with documented adenocarcinoma of the colon and/or rectum who have undergone complete resection of primary tumor and have nonresectable liver metastases that do not exceed 75% of the liver volume. PATIENTS AND METHODS A total of 168 patients at 25 treatment centers were enrolled onto this prospective, multicenter, randomized study. The three treatment arms were as follows: (1) fluorouracil (5-FU)/leucovorin (LV) administered via hepatic arterial infusion (HAI), (2) 5-FU/LV administered via intravenous (IV) infusion, and (3) fluorodeoxyuridine (FUDR) administered via HAI. RESULTS Median times to disease progression for the three treatment arms were as follows: 9.2 months for patients treated with HAI 5-FU/LV, 6.6 months for IV 5-FU/LV, and 5.9 months for HAI FUDR. Median survival times for patients treated with HAI 5-FU/LV, IV 5-FU/LV, and HAI FUDR were 18.7 months, 17.6 months, and 12.7 months, respectively. There was a nearly two-fold increase in time to progression in addition to a survival benefit among patients with an intrahepatic tumor burden of less than 25% who were treated with HAI 5-FU/LV. The most common adverse events were stomatitis, nausea and vomiting, skin irritation, diarrhea, and elevated serum levels of liver enzymes. Some patients exhibited severe reactions, including biliary sclerosis and chemical hepatitis. CONCLUSION Although the use of HAI 5-FU/LV as a means of treating liver metastases after resection of colorectal carcinoma warrants further investigation, it cannot be recommended as a routine therapeutic measure at this time.
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Affiliation(s)
- M Lorenz
- Department of General and Vascular Surgery, Johann Wolfgang Goethe-Universit]at, Frankfurt am Main, Germany.
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27
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Bar F, Battista S, Bucchi MC, Zanon C, Grosso M, Alabiso O, Miraglia S, Cappello N, Gariboldi A, Molino G. Sorbitol removal by the metastatic liver: a predictor of systemic toxicity of intra-arterial chemotherapy in patients with liver metastases. J Hepatol 1999; 30:1112-8. [PMID: 10406191 DOI: 10.1016/s0168-8278(99)80267-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIM Hepatic arteriovenous shunting in the metastatic liver reduces the advantages of intraarterial infusion of chemotherapeutic agents because of the passage of drugs into the systemic circulation. The aim of this study was to quantitatively assess spontaneous functional hepatic arteriovenous shunting in patients with liver metastases and to determine its implication in the increase in systemic toxic effects of intra-arterial infusion chemotherapy with floxuridine. METHODS Twenty-five patients who underwent implantation of arterial ports for regional chemotherapy of liver metastases were studied. Functional hepatic arterio-venous shunting was evaluated through the bioavailability of intra-arterially administered D-sorbitol, a safe, natural compound whose kinetic features make its hepatic clearance flow dependent. In addition, D-sorbitol hepatic clearance (a parameter reflecting functional liver blood flow) and common liver function tests were evaluated for each studied patient. Patients were then grouped with respect to the percentage of medically-assessed liver occupation by metastases and with respect to systemic toxicity of the chemotherapeutic treatment. Both univariate and multivariate analyses by Student's t-test and stepwise logistic regression, respectively, were performed in both groups for each of the evaluated parameters (age, liver function tests, D-sorbitol hepatic clearance and arterial bioavailability). RESULTS Arterial bioavailability of D-sorbitol ranged between 0.05 and 0.72 and was significantly greater in patients with more than 50% liver occupation (0.39+/-0.19) compared with those with minor liver involvement (0.17+/-0.13; p = 0.003); it was also significantly greater in patients experiencing high-grade systemic toxicity (0.40+/-0.19) compared with those with low-grade toxicity (0.16+/-0.11; p<0.001). Multivariate analysis showed that arterial bioavailability of D-sorbitol was the only parameter among those evaluated which was able to predict systemic toxicity of this kind of chemotherapy. CONCLUSIONS Our results show that, in the metastatic liver, arterial bioavailability of D-sorbitol, an index of functional arteriovenous shunting, varies widely, is significantly greater in patients with massive liver occupation and it is a good predictor of systemic toxicity of intra-arterial regional chemotherapy with floxuridine.
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Affiliation(s)
- F Bar
- Division of General Medicine A, San Giovanni Battista Hospital, Turin, Italy
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Rougier P. Are there indications for intraarterial hepatic chemotherapy or isolated liver perfusion? The case of liver metastases from colorectal cancer. Recent Results Cancer Res 1998; 147:3-12. [PMID: 9670263 DOI: 10.1007/978-3-642-80460-1_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intraarterial hepatic chemotherapy (IAHC) has been used for many years to treat liver tumors (primary or secondary) if no extrahepatic extension exists, when no resection is feasible, and when no active systemic chemotherapy is available. Liver metastases from colorectal cancer represent one of the best indications, and many trials have demonstrated that IAHC is an efficient treatment. Some of these trials were randomized and have demonstrated that IAHC significantly increases the response rate using IA FUDR compared to its systemic administration, and increases the overall survival compared to symptomatic treatment or systemic bolus 5FU. Liver toxicity and extrahepatic progression are the two main limiting factors which can be reduced using new protocols and combinations with systemic chemotherapy. New drugs such as THP adriamycin will become available for IAHC in the future. Isolated liver perfusion adds to IAHC an extracorporal extraction and allows the use of higher doses of chemotherapy. Its efficacy has been suggested in small phase II trials; however, its relative complexity and the lack of clear demonstration of its efficacy compared to the most recent and effective systemic chemotherapies used alone or in combination with IAHC prevent the recommendation of its use outside clinical trials. IAHC and isolated liver perfusion are two active locoregional treatments which can be combined with surgical resection and/or systemic chemotherapy and warrant further development, if possible, in randomized trials.
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Affiliation(s)
- P Rougier
- Service d'hepato-gastroenterologie, Hopital Ambroise Parè, Boulogne, France
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29
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Hepatic arterial infusion chemotherapy with 5-fluorouracil-based regimens in the management of liver metastases of colorectal carcinoma. Int J Clin Oncol 1998. [DOI: 10.1007/bf02489911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Ischemia-induced bile duct lesions have been collectively labeled as ischemic cholangitis. The biliary epithelium is dependent on arterial blood flow, unlike the hepatic parenchyma with its dual arterial and portal venous blood supply. As such, the biliary epithelium is susceptible to injury when arterial blood flow is compromised. This compromise can occur at the level of the major, named hepatic artery branches or at the microscopic, peribiliary capillary plexus level. Typically, ischemic cholangitis manifests as segmental strictures and cholangiectases with resultant mechanical impairment of bile flow and, occasionally, secondary infection of the biliary system. Ischemic cholangitis after liver transplantation is becoming an important problem and likely is attributable to numerous factors. Hepatic arterial infusion of chemotherapy and systemic vasculitis are other causes of ischemic cholangitis. The role of ischemia in other chronic biliary and ductopenic diseases remains speculative.
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Affiliation(s)
- K P Batts
- Division of Anatomic Pathology, Mayo Clinic Rochester, Minnesota 55905, USA
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Crystal RG, Hirschowitz E, Lieberman M, Daly J, Kazam E, Henschke C, Yankelevitz D, Kemeny N, Silverstein R, Ohwada A, Russi T, Mastrangeli A, Sanders A, Cooke J, Harvey BG. Phase I study of direct administration of a replication deficient adenovirus vector containing the E. coli cytosine deaminase gene to metastatic colon carcinoma of the liver in association with the oral administration of the pro-drug 5-fluorocytosine. Hum Gene Ther 1997; 8:985-1001. [PMID: 9195221 DOI: 10.1089/hum.1997.8.8-985] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- R G Crystal
- Rockefeller University Hospital, New York, New York 10021, USA
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Bromage PR. Paraplegia in a patient who by chance missed the insertion of an epidural catheter. Anesth Analg 1996; 83:1351. [PMID: 8942621 DOI: 10.1097/00000539-199612000-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kurth S, Bulian D, Kreft B, Riemenschneider T. Intraarterial hepatic chemotherapy with fluorouracil, fluorodeoxyuridine, mitomycin C, cisplatin or methotrexate as single-agent anticancer drugs for a transplanted experimental liver tumor in rats. J Cancer Res Clin Oncol 1996; 122:421-6. [PMID: 8690753 DOI: 10.1007/bf01212882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A prospective, controlled and standardized animal experiment was performed to study the influence of various anticancer drugs. The Novikoff hepatoma transplanted into male Sprague-Dawley rats was treated with fluorouracil (FUra), mitomycin C, methotrexate, cisplatin and fluorodeoxyuridine (FdUrd) at equi-effective dosage, in terms of side effects (weight loss), in comparison to a control group (0.9% saline solution) by locoregional application via the hepatic artery. The tumor multiplication factor (TMF = tumor volume day 12/tumor volume day 5) served as the parameter to compare the tumor growth of the various groups. All drugs showed a significant (P < 0.05) effect on the tumor growth. In comparison to the control group (mean TMF 9.66), FdUrd (3.78) and FUra (3.03) only limited the tumor growth, mitomycin C (0.96) produced stable tumor, cisplatin (0.64) and methotrexate (0.15) significantly reduced (P < 0.01) the tumor size. We suggest that, in addition to the established (FUra, FdUrd, mitomycin C) drugs, methotrexate and cisplatin should be considered in further studies of the treatment of primary and secondary liver malignancies.
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Affiliation(s)
- S Kurth
- Klinik und Poliklinik für Chirurgie der Universität Bonn, Germany
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36
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Abstract
Almost one-third of patients dying from colorectal cancer have tumor limited to the liver. Systemic chemotherapy is the appropriate palliative management of patients with metastases to the liver and other sites. For many patients with isolated hepatic metastases, systemic chemotherapy is also the most appropriate treatment. However, results with systemic chemotherapy indicate that one-third or less of patients will respond to such treatments, and long-term survival is rare. In this report we provide information concerning the natural history of colorectal hepatic metastases, followed by the expected benefits with systemic chemotherapy. This information provides background for the regional therapeutic strategies of surgical resection, cryosurgery, and hepatic artery chemotherapy. We discuss the selection factors appropriate for such treatments, morbidity and mortality, and the potential long-term benefits of such approaches. The last section focuses on surgical considerations in hepatic resection and hepatic artery chemotherapy.
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Affiliation(s)
- Y Fong
- Colorectal Service, Department of Surgery, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Seki H, Kimura M, Kamura T, Miura T, Yoshimura N, Sakai K. Hepatic perfusion abnormalities during treatment with hepatic arterial infusion chemotherapy: value of CT arteriography using an implantable port system. J Comput Assist Tomogr 1996; 20:343-8. [PMID: 8626887 DOI: 10.1097/00004728-199605000-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to evaluate CT arteriography (CTA) using an implantable port system in the detection of perfusion abnormalities occurring during hepatic arterial infusion chemotherapy (HAIC). METHOD In 51 patients with unresectable primary and metastatic liver tumors, who had implanted port systems for HAIC, CTA examinations through the infusion pump were performed. When perfusion abnormalities were found, selective angiography and/or digital subtraction angiography using the implantable port system were performed to determine the etiology. RESULTS Forty-nine perfusion abnormalities were detected in 32 patients. Intrahepatic hypoperfusion was found in 24 cases. Of 11 patients in whom correction of the hypoperfusion was attempted, it was successful in 10. Of 13 patients in whom correction was not attempted, 6 patients showed progressive disease in nonperfused areas. Intrahepatic hyperperfusion was found in 14 cases, which showed no subsequent complication. Extrahepatic perfusion was found in 11 cases. CONCLUSION We consider CTA to be useful in detecting perfusion abnormalities that may compromise HAIC.
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Affiliation(s)
- H Seki
- Department of Radiology, Niigata University School of Medicine, Japan
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Chow LW, Lim BH, Leung SY, Branicki FJ, Gertsch P. Gastric carcinoma with synchronous liver metastases: palliative gastrectomy or not? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:719-23. [PMID: 7487711 DOI: 10.1111/j.1445-2197.1995.tb00544.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
During a 6 year period, 38 patients with gastric cancer presented with synchronous liver metastases and 25 underwent gastric resection. Forty per cent of the operated patients presented with complications, whereas most of the non-operated patients presented with pain or an abdominal mass. Eight patients (32%) developed postoperative morbidity, five of whom died (20%). The median duration of hospital stay for those surviving surgery was 33 days. In the non-operated group 61% died while in hospital and the median duration of hospital stay was 28 days. The respective median survival time and duration of home stay were 13 and 9 weeks for the operated patients and 6 and 3 weeks for the non-operated patients. The difference of the duration of home stay between the two groups of patients was statistically insignificant. There was also no significant relief of pain after surgery. Univariate analyses of the influence on survival time of operation among 13 other factors showed that only bilirubin was significant. We conclude that gastrectomy neither prolongs life nor improves the quality of survival in patients with gastric cancer and discontiguous liver metastases. However, gastrectomy may be beneficial in selected patients presenting with potentially lethal complications such as bleeding and obstruction.
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Affiliation(s)
- L W Chow
- Department of Surgery, University of Hong Kong, Queen Mary Hospital
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Fordy C, Burke D, Earlam S, Twort P, Allen-Mersh TG. Treatment interruptions and complications with two continuous hepatic artery floxuridine infusion systems in colorectal liver metastases. Br J Cancer 1995; 72:1023-5. [PMID: 7547216 PMCID: PMC2034031 DOI: 10.1038/bjc.1995.455] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Continuous hepatic artery floxuridine infusion benefits patients with colorectal liver metastases. Implanted infusion pumps are more expensive but may result in fewer treatment interruptions than when using an external pump connected to a port. We have assessed device-related complications, treatment interruptions and added nurse interventions in 95 patients undergoing a total of 959 treatment cycles via either implanted pump (64 patients) or port (31 patients). Compared with the implanted pump, the port was associated with a significant increase (P < 0.003) in catheter blockage (24/31 vs 2/64 patients), treatment interruption (15/265 vs 12/694 treatments) and added nurse intervention (80/265 vs 20/694 treatments). Survival in patients with colorectal liver metastases is limited and the complications of treatment should be kept to a minimum. An implanted subcutaneous infusion pump offers the benefit of a 3-fold lower incidence of treatment interruption and a 30-fold lower incidence of catheter blockage than when continuous infusion chemotherapy is given via an external infusion device.
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Affiliation(s)
- C Fordy
- Department of Surgery, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London, UK
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Abstract
OBJECTIVE To provide an overview of access devices used to treat cancers through the arterial, peritoneal, and intraventricular body systems. CONCLUSIONS Short-term and long-term devices have been developed over the last 35 years for cancer treatment. Although less amenable to standard methods of therapy, the various access devices available to access the arterial, peritoneal, and intraventricular systems have provided a safe and reliable means for drug therapy. Access devices assist in delivering high concentrations of drugs directly to the center of the tumor. Complications and toxicities are inherent with these devices from the drug therapy as well as the device. Nursing assessment can provide early identification of potential problems and implementation of appropriate interventions. IMPLICATIONS FOR NURSING PRACTICE As the availability of these devices increases, so must the nurse's knowledge base to provide optimal safe care. Oncology nurses are challenged to know the differences between the devices, the device of choice for the individual patient, insertion procedures, and maintenance protocols.
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MESH Headings
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/supply & distribution
- Chemotherapy, Cancer, Regional Perfusion
- Humans
- Infusions, Intra-Arterial/adverse effects
- Infusions, Intra-Arterial/instrumentation
- Infusions, Intra-Arterial/nursing
- Injections
- Injections, Intraperitoneal/adverse effects
- Injections, Intraperitoneal/instrumentation
- Injections, Intraperitoneal/nursing
- Injections, Intraventricular/adverse effects
- Injections, Intraventricular/instrumentation
- Injections, Intraventricular/nursing
- Neoplasms/drug therapy
- Neoplasms/nursing
- Nursing Assessment
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Affiliation(s)
- L Almadrones
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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41
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Blumgart LH, Fong Y. Surgical options in the treatment of hepatic metastasis from colorectal cancer. Curr Probl Surg 1995; 32:333-421. [PMID: 7538062 DOI: 10.1016/s0011-3840(05)80012-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Current data indicate that liver resection is the only available treatment that regularly produces long-term survival with possible cure in patients with metastatic colorectal carcinoma to the liver. Although a number of clinical or pathologic factors predicts a poor outcome, the only absolute contraindications to liver resection are general health incompatible with recovery from major hepatic resection or clear evidence of wide dissemination of disease. Important areas for future study include the potential role of adjuvant regional chemotherapy after resection and cryoablation of "close" margins. For patients with unresectable disease, operative therapy also plays an important role. Multiple operative modalities hold promise in palliative treatment in the setting of clinically incurable disease. It is imperative that a large randomized trial of regional chemotherapy be performed allowing no crossover and with mortality as an endpoint. Additionally, the role of cryoablation begs systematic investigation to ensure proper use of this modality.
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Affiliation(s)
- L H Blumgart
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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42
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Arisawa Y, Sutanto-Ward E, Fortunato L, Sigurdson ER. Hepatic artery dexamethasone infusion inhibits colorectal hepatic metastases: a regional antiangiogenic therapy. Ann Surg Oncol 1995; 2:114-20. [PMID: 7537164 DOI: 10.1007/bf02303625] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A randomized trial treating colorectal hepatic metastases demonstrated that hepatic arterial floxuridine (FUdR) with dexamethasone increased tumor response compared with hepatic arterial FUdR alone (Cancer 1992;69:327-34). The mechanism of this improvement is unclear. METHODS We investigated the effect of hepatic arterial dexamethasone with or without FUdR on the growth of colorectal hepatic metastases in an animal model. BD-IX rats were inoculated intrasplenically with 10(7) K12/TRb colon cancer cells on day 0. On day 14, the hepatic metastases were counted and hepatic arterial catheters placed for chemotherapy. Forty-eight animals were randomized to 4 groups for 14 days of infusion with heparinized saline alone (group A), heparinized saline with dexamethasone 0.03 mg/kg/d (group B), heparinized saline with FUdR 2 mg/kg/d (group C), or heparinized saline with dexamethasone 0.03 mg/kg/d plus FUdR 2 mg/kg/d (group D). The hepatic metastases were recounted by laparotomy on day 28. Response in each rat was expressed in terms of percentage change in number of hepatic nodules between the number of hepatic nodules seen on days 14 and 28. In vitro chemosensitivity of K12/TRb to dexamethasone with or without FUdR was examined using an MTT (3-(4,5-dimethylthiazole-2-yl-2,5-diphenyltetrazolium bromide; Sigma, St. Louis, MO, U.S.A.) assay. The effect of dexamethasone on tumor-induced angiogenesis was tested using an in vivo assay. RESULTS The mean percentage change in tumor nodules was +129% in group A, +17% in group B, -4% in group C, and -29% in group D (p = 0.002 A vs. B, p = 0.04 C vs. D). The MTT assay showed that dexamethasone had no direct effect on K12/TRb growth or on tumor FUdR sensitivity. Dexamethasone inhibited K12/TRb-induced angiogenesis in vivo. CONCLUSIONS Hepatic arterial dexamethasone is effective in treating colorectal hepatic metastases and is more effective when combined with hepatic arterial FUdR. The antiangiogenic activity of dexamethasone may partially contribute to its efficacy.
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Affiliation(s)
- Y Arisawa
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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43
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Okada M, Kudo S, Miyazaki O, Saino T, Ekimoto H, Iguchi H, Hirano S, Kuboki H, Kadosawa H, Takeuchi T. Antitumoral efficacy and pharmacokinetic properties of pirarubicin upon hepatic intra-arterial injection in the rabbit V x 2 tumour model. Br J Cancer 1995; 71:518-24. [PMID: 7880733 PMCID: PMC2033641 DOI: 10.1038/bjc.1995.103] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To improve the efficiency of hepatic intra-arterial (h.i.a.) chemotherapy, we selected pirarubicin (THP) because it shows good properties for h.i.a. chemotherapy, such as fast and efficient cellular uptake, and used it for h.i.a. chemotherapy in rabbits with V x 2 tumour implanted in the liver. The anti-tumour effect of THP upon h.i.a. administration was compared with that upon intravenous (i.v.) injection and also with the anti-tumour activity of epirubicin (EPI) upon h.i.a. injection using optimal and maximal tolerated doses of each drug. When tumour growth rates and morphometric examinations were evaluated, it was found that THP and EPI were effective against V x 2 tumour when injected via the h.i.a. route. The activity of THP was stronger than that of EPI. As regards h.i.a. injection-related complication, plasma transaminase levels were temporarily elevated. To demonstrate higher anti-tumour activity and other advantages of h.i.a. injection of THP, plasma and tumour drug concentrations were determined by high-performance liquid chromatography after THP or EPI was administered at an equal dose to the rabbit V x 2 model. Hepatic intra-arterial injection of THP accomplished a selective and higher uptake into the tumour and lower effusion into the plasma than i.v. injection of THP or h.i.a. injection of EPL. Our findings indicate that THP is the better candidate of the two drugs tested for the h.i.a. chemotherapy because of its greater anti-tumour activity and the lower systemic drug exposure achieved upon h.i.a. injection.
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MESH Headings
- Animals
- Antibiotics, Antineoplastic/metabolism
- Antibiotics, Antineoplastic/pharmacokinetics
- Antibiotics, Antineoplastic/pharmacology
- Aspartate Aminotransferases/blood
- Biliary Tract/drug effects
- Bilirubin/blood
- Dose-Response Relationship, Drug
- Doxorubicin/analogs & derivatives
- Doxorubicin/metabolism
- Doxorubicin/pharmacokinetics
- Doxorubicin/pharmacology
- Epirubicin/metabolism
- Epirubicin/pharmacokinetics
- Epirubicin/pharmacology
- Female
- Hepatic Artery
- Image Processing, Computer-Assisted
- Injections, Intra-Arterial
- Injections, Intravenous
- Liver/drug effects
- Liver/pathology
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/metabolism
- Liver Neoplasms, Experimental/pathology
- Neoplasm Transplantation
- Rabbits
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Affiliation(s)
- M Okada
- Research Laboratories, Nippon Kayaku Co. Ltd., Tokyo, Japan
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44
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van der Wilt CL, Marinelli A, Pinedo HM, Cloos J, Smid K, van de Velde CJ, Peters GJ. The effect of different routes of administration of 5-fluorouracil on thymidylate synthase inhibition in the rat. Eur J Cancer 1995; 31A:754-60. [PMID: 7640050 DOI: 10.1016/0959-8049(94)00477-m] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A rat colon tumour model of liver metastases was used to administer 5-fluorouracil (5FU) by intraperitoneal (i.p.) bolus injection (50 mg/kg), isolated liver perfusion (ILP, 150 mg/kg) and hepatic artery infusion (HAI, 50 mg/kg). The biochemical effect of 5FU, delivered by different routes, on its target enzyme thymidylate synthase (TS) was studied in both tumour and normal tissues of the rat. In tumour tissue, only small differences were observed in the extent of TS inhibition. A pronounced inhibition of TS was observed 3 h after 5FU administration by all routes, but was followed by a recovery of TS activity within 24 and 48 h. Effects of 5FU on normal tissues were diverse. In liver, TS activity increased 6-fold after ILP and HAI administration of 5FU, and a 2-fold increase of FdUMP binding to TS was seen for all routes of administration. In intestinal mucosa, both induction of TS activity (by ILP) and inhibition of TS activity (by HAI) were observed, while i.p. injection did not cause major changes. TS activity and FdUMP binding to TS in bone marrow was strongly inhibited after administration of 5FU by all routes, but administration by ILP seemed slightly advantageous, since a smaller extent of TS inhibition was observed compared to the other routes of administration. 5FU given by ILP had a small antitumour effect in this colon tumour model, while HAI administration had no antitumour activity. Since this difference in antitumour activity could not be related to differences in TS inhibition in the tumour, the RNA-directed mechanism of action of 5FU could be involved. Focusing on the effects of TS, we may conclude that the ILP administration of 5FU offered the important advantage of a lack of severe TS inhibition in normal tissues, which corresponds with the low systemic toxicity observed.
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45
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Muretto P. Liver lesions in cryoglobulinaemia associated with gastric non-Hodgkin lymphoma: a case report. LIVER 1994; 14:323-5. [PMID: 7877438 DOI: 10.1111/j.1600-0676.1994.tb00097.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Liver lesions in cryoglobulinaemia, associated with gastric non-Hodgkin lymphoma, are described in a 67-year-old woman. Histological examination showed capillaropoiesis in some portal tracts with vessels containing amorphous, eosinophilic and PAS-positive material, which immunohistochemically was shown to contain IgM and k light-chains.
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Affiliation(s)
- P Muretto
- Department of Pathology, Ospedale S. Salvatore, Pesaro, Italy
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46
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Allen-Mersh TG, Earlam S, Fordy C, Abrams K, Houghton J. Quality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet 1994; 344:1255-60. [PMID: 7526096 DOI: 10.1016/s0140-6736(94)90750-1] [Citation(s) in RCA: 423] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Very few patients with liver metastases from colorectal cancer can be cured. We have investigated whether a treatment to slow the growth of liver metastases, hepatic-artery infusion of floxuridine, improves palliation in this setting. In a randomised study of 100 patients, we compared quality of life and survival in patients who received hepatic-artery infusion of floxuridine and in those who received conventional symptom palliation. 95% of control patient survival time was spent with normal quality-of-life scores, which suggests that the aim of treatment should be to prolong normal-quality survival rather than merely to sustain quality of life. There was a significant prolongation (p = 0.03) in overall survival in floxuridine-treated patients compared with controls (median 405 vs 226 days). There were similar significant prolongations in normal-quality (ie, normal symptom scores) survival for physical symptoms (p = 0.04), anxiety (p = 0.04), and depression (p = 0.04). This survival benefit was associated with significant reductions in metastasis size on computed tomography (p = 0.001) and in serum carcinoembryonic antigen concentration (p = 0.006) in floxuridine-treated patients. There was no evidence of treatment-related hepatotoxicity as assessed by serum aspartate aminotransferase and bilirubin measurements. This is the first demonstration that survival can be prolonged with normal quality of life in patients with colorectal liver metastases. We conclude that hepatic-artery floxuridine infusion can be recommended for suitable patients.
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47
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Arisawa Y, Sutanto-Ward E, Dalton RR, Sigurdson ER. Short-term intrahepatic FUdR infusion combined with bolus mitomycin C: reduced risk for developing drug resistance. J Surg Oncol 1994; 56:75-80. [PMID: 8007682 DOI: 10.1002/jso.2930560205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluates tumor response, survival, and development of resistance to HAI chemotherapy, comparing a combination of bolus MMC and short duration FUdR to short duration FUdR alone or to long duration FUdR alone, using a rat hepatic metastases model. After intrasplenic injection of 10(7) K12/TRb colon cancer cells in BD-IX rats on day 0, hepatic metastases were evaluated and HA catheters were placed on day 14. The response was determined on day 28. Chemosensitivity of the hepatic metastases after HAI treatments was determined using the MTT assay. Bolus MMC with short duration FUdR as well as long-term FUdR alone provided better hepatic tumor response and survival than short-term FUdR alone. However, bolus MMC with short duration FUdR decreased the acquired resistance to FUdR, compared to long-term FUdR, without causing resistance to MMC. These results provide a rationale for using short duration of FUdR in combination with other drugs.
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Affiliation(s)
- Y Arisawa
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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48
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Cortesi E, Capussotti L, Di Tora P, Mannella E, Casaldi V, Civalleri D, Morandi GB, Da Pian PP, Padovani A, Callopoli A. Bolus vs. continuous hepatic arterial infusion of cisplatin plus intravenous 5-fluorouracil chemotherapy for unresectable colorectal metastases. Dis Colon Rectum 1994; 37:S138-43. [PMID: 8313786 DOI: 10.1007/bf02048447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
UNLABELLED A multicenter, randomized Phase 2 study that compared patients, affected by colorectal liver metastases, who received intrahepatic arterial infusion with two different schedules of cisplatin, bolus vs. continuous infusion, and systemic 5-fluorouracil. PURPOSE The aim of this study was to validate results of a previous Phase 2 trial on bolus cisplatin intrahepatic arterial infusion, which reported a 47 percent response rate and a 32 percent 4-year survival rate for Gennari's Stage 2 patients, with a high rate of neurologic, gastrointestinal, and hematologic toxicity. METHODS One hundred nine patients were randomized in a Phase 2 study to receive cisplatin intrahepatic arterial infusion (24 mg/m2/day, 1-->5, bolus vs. continuous infusion) and systemic intravenous 5-fluorouracil (250, 375, or 500 mg/m2/day, 1-->5; escalating doses, respectively, at cycles I, II, III, and VI). To avoid neurotoxicity a maximum of six cycles was administered. RESULTS Preliminary results for the 78 evaluable patients are similar to those of the previous study: response rate 46 percent and at a median follow-up of 16.5 months, the overall survival was 16.5 months, with 45 percent of the patients who received more than 3 cycles alive at 3 years. Toxicity, evaluable in 99 patients, showed a decreased incidence of neurotoxicity and a tolerable gastrointestinal and hematologic toxicity, lower in the cisplatin continuous infusion arm. CONCLUSION This study clearly shows that cisplatin intrahepatic arterial infusion is able to provide a good palliative effect with a tolerable toxicity.
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Affiliation(s)
- E Cortesi
- University of Rome, La Sapienza, Italy
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49
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Kobayashi S, Nakanuma Y, Matsui O. Histopathology of portal tracts in livers after transcatheter arterial chemo-embolization therapy for hepatocellular carcinoma. J Gastroenterol Hepatol 1994; 9:45-54. [PMID: 8155866 DOI: 10.1111/j.1440-1746.1994.tb01215.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To study the influence of transcatheter arterial embolization therapy (TAE) on the portal tracts, 32 cases of hepatocellular carcinoma (HCC) with a history of TAE were examined. Portal tract elements are said to be mainly supplied by hepatic arterial blood, as is HCC. The following changes were found: peribile duct fibrosis; biliary epithelial injuries; bile duct necrosis; fibrous thickening of the intima and adventitia of arteries; thrombosis or stenosis of portal vein branches; and fibrosis of portal tract itself. We failed to correlate these histopathologic changes with the frequency of TAE or the interval between TAE therapy and surgery or autopsy. Semi-quantitative assessment disclosed that vessels of the peribiliary vascular plexus (PVP) which are known to be derived from hepatic arterial branches, were considerably decreased. There was little correlation between the degree of reduction of PVP and the observed histopathologic changes of portal tracts. It is suggested that TAE causes adverse effects on the elements of portal tracts and a reduction in the PVP in the vicinity of HCC, but the relationship between them is unclear.
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Affiliation(s)
- S Kobayashi
- Department of Pathology (II), Kanazawa University School of Medicine, Japan
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50
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Curley SA, Roh MS, Chase JL, Hohn DC. Adjuvant hepatic arterial infusion chemotherapy after curative resection of colorectal liver metastases. Am J Surg 1993; 166:743-6; discussion 746-8. [PMID: 8273861 DOI: 10.1016/s0002-9610(05)80691-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We performed a prospective study of adjuvant hepatic arterial infusion chemotherapy after resection of colorectal liver metastases. We placed hepatic arterial infusion ports in 20 consecutive patients undergoing curative resection of colorectal liver metastases. The chemotherapy regimen was a weekly bolus of 5-fluorouracil (15 mg/kg) for 6 months. The median follow-up has been 33 months. Nine of the 18 evaluable patients (50%) have developed recurrent colorectal cancer. The liver was the only site of failure in 3 of 18 patients (17%), and extrahepatic recurrences occurred in 6 of 18 patients (33%). All patients without recurrence are alive. The median survival of the patients without recurrent disease is 39 months, compared with 27 months for those with recurrent metastatic disease (p < 0.01). In patients who received adjuvant hepatic arterial infusion chemotherapy compared with historical controls treated with surgery alone, we have observed a decreased incidence of recurrent disease after liver resection for metastases. We recommend that patients who undergo hepatic resection for colorectal metastases be considered for postoperative adjuvant chemotherapy to decrease the likelihood of recurrence and to improve survival.
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Affiliation(s)
- S A Curley
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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