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Anteby R, Kemeny NE, Kingham TP, D'Angelica MI, Wei AC, Balachandran VP, Drebin JA, Brennan MF, Blumgart LH, Jarnagin WR. Getting Chemotherapy Directly to the Liver: The Historical Evolution of Hepatic Artery Chemotherapy. J Am Coll Surg 2021; 232:332-338. [PMID: 33387624 PMCID: PMC8320676 DOI: 10.1016/j.jamcollsurg.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Roi Anteby
- School of Public Health, Harvard University, Boston, MA; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Nancy E Kemeny
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alice C Wei
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jeffrey A Drebin
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Murray F Brennan
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie H Blumgart
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William R Jarnagin
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Livraghi T, Bajetta E, Matricardi L, Villa E, Lovati R, Vettori C. Fine Needle Percutaneous Intratumoral Chemotherapy under Ultrasound Guidance: A Feasibility Study. TUMORI JOURNAL 2018; 72:81-7. [PMID: 3513408 DOI: 10.1177/030089168607200112] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To test the feasibility of fine needle (22 gauge) percutaneous intratumoral chemotherapy (PIC) under ultrasound guidance, a trial was conducted on 12 selected neoplastic patients with tumors not responsive to conventional treatments (5 adenocarcinomas of the pancreas, 1 hepatocellular carcinoma, 1 squamous cell carcinoma of the lung, 1 leiomyosarcoma of the hepatic hilum, 1 malignant fibrous histiocytoma of the ischiatic region, 2 liver and 1 peritoneal metastases). The drugs used were 5-fluorouracil, methotrexate and cyclophosphamide, according to the histotype. The doses given never exceeded the routine intravenous doses; 119 sessions of PIC were administered. There have been no significant local complications due to needle injury and drug toxicity or biochemical changes attributable to general toxicity. Partial or total pain control and stable disease or response to 60% was observed. This research has not been described previously to our knowledge.
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Kumar V, Ramaswami N, Pandey A, Shukla RC, Sen MR, Sharma SP, Gupta DK, Gangopadhyay AN. Clinico-immunological response to intratumoral versus intravenous neoadjuvant chemotherapy in advanced pediatric solid malignancies. Indian J Med Paediatr Oncol 2013; 34:80-4. [PMID: 24049292 PMCID: PMC3764749 DOI: 10.4103/0971-5851.116183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms’ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms’ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms’ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucositis, and thrombophlebitis were more common in the intravenous group (P<0.05). The fall in Immunoglobulin A, Immunogloblulin G, Immunoglobulin M, and T-cell rosetting was more common in the intravenous group (P<0.05). Seventy percent of patients had completely resectable tumor at the end of 6 doses of intratumoral chemotherapy as compared to 50% resectability in the intravenous group (P<0.05). Conclusion: Intratumoral chemotherapy, besides causing less of the adverse effects and increasing the resecability rate, also causes less suppression of the immune system. This may be offered as an alternative safe and effective modality of treatment for advanced solid tumors.
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Affiliation(s)
- Vijayendra Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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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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Zhu AL, Liu LX, Piao DX, Lin YX, Zhao JP, Jiang HC. Liver regional continuous chemotherapy: Use of femoral or subclavian artery for percutaneous implantation of catheter-port systems. World J Gastroenterol 2004; 10:1659-62. [PMID: 15162545 PMCID: PMC4572774 DOI: 10.3748/wjg.v10.i11.1659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To evaluate the feasibility and safety of the intraarterial chemotherapy of the liver cancer by an interventional method, catheter-port system.
METHODS: Thirty-two catheter-port systems were implanted percutaneously via the femoral artery or subclavian artery. Chemotherapies were performed 0-5 d after the implantation of the catheter-port systems. The mean interval between two sequent chemotherapies was 4 wk. The occurrence of side effects of the implantation was examined clinically.
RESULTS: Implantation of the catheter-port was successful in all patients. Mean patency period was 210 d. One occlusion (3.1%) of the catheter was observed. Displacement of the catheter was observed in one case (3.1%). One patient rated a hematoma in the chest wall as important. Mild hematoma was reported in 8 cases (25%). In 3 of 32 cases (9.4%), mild pain was reported initially, and dysesthesia was reported in seven (21.9%). No patient rated overall discomfort as mild, severe, or important.
CONCLUSION: Percutaneous placement is feasible and safe for liver regional continuous chemotherapy. Compared with surgical placement, the overall complication rate is comparable or less.
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Affiliation(s)
- An-Long Zhu
- Department of General surgery, First Clinical College, Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
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6
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Copur MS, Capadano M, Lynch J, Goertzen T, McCowan T, Brand R, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. J Clin Oncol 2001; 19:2404-12. [PMID: 11331319 DOI: 10.1200/jco.2001.19.9.2404] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the objective response to a short course of hepatic arterial infusion (HAI) using temporary, percutaneously placed catheters alternating with systemic prolonged continuous infusion fluorouracil (ci 5-FU) and daily oral leucovorin (L). PATIENTS AND METHODS Eligible patients were previously untreated (except for adjuvant therapy) adults with liver-predominant metastases, with Eastern Cooperative Oncology Group performance status of 0 to 2. Treatment regimen included HAI with fluorodeoxyuridine (FUDR) 60 mg/m2/d and L 15 mg/m2/d continuously infused daily for 4 days. After a 1-week rest, ci 5-FU was administered through a central venous access device using a dose of 180 mg/m2/d with a fixed dose of oral L at 5 mg/m2/d for 21 out of 28 days. Cycles were repeated every 6 weeks. After four cycles of therapy, patients were maintained on ci 5-FU and daily oral L until evidence of progression. RESULTS Forty-three patients were enrolled onto this trial. One patient was ineligible. The objective response rate for all patients (17 partial, zero complete) was 41% (95% confidence interval [CI], 26% to 56%). Five patients were not able to receive at least one complete cycle of HAI. Among patients who received at least one complete cycle of HAI, the response rate was 46% (95% CI, 30% to 62%). Five patients underwent a liver resection after enrolling onto the protocol. At the time of analysis, estimated median time to progression was 6 months, and estimated median overall survival was 13 months. CONCLUSION The objective response rate was comparable to that achieved with more prolonged and more frequent HAI using FUDR. This approach should be studied as an acceptable alternative to surgically placed hepatic arterial catheters/pumps and may have a role as neoadjuvant therapy for liver metastases that are unresectable, as well as an adjuvant role for patients with resected hepatic metastatic colorectal cancer.
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Affiliation(s)
- M S Copur
- University of Nebraska Medical Center, Omaha, and Saint Francis Cancer Center, Grand Island, NE, USA
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7
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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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8
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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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Matsuda T, Yamagishi H, Jin MB, Kobayashi Y, Sonoyama T, Oka T. Laparotomy versus interventional radiological procedures for the implantation of arterial infusion devices. Surg Today 1997; 27:398-402. [PMID: 9130340 DOI: 10.1007/bf02385701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although there have been numerous reports on implantable infusion devices for chemotherapy of patients with malignancy, we occasionally face problems with this therapy due to trouble with implantation. We performed a retrospective review of 81 implantations in 77 patients, who were treated with intraarterial chemotherapy via implanted devices from 1985 to 1993. They were divided into two groups according to the procedures: the operative procedure group (group A, n = 41) and the interventional radiological procedure group (group B, n = 36). Both groups were then analyzed regarding the respective complications. We experienced 25 complications: (a) 9 obstructions of the catheter, (b) 4 infections, (c) 4 dislocations of the catheter, (d) 3 hematomas, (e) 3 breakdowns of the device, (f) 1 pneumothorax, and (g) 1 hepatic artery occlusion. The results of a comparison of the complication rate between groups A and B were (a) 14.0%:8%, (b) 4%:0%, (c) 0%:10%, (d) 4%:2%, (e) 7%:0%, (f) 0%:2%, and (g) 2%:0%, respectively. A statistically significant difference was observed for (b) and (c) (P < 0.05). Infection occurred mainly in the cirrhotic cases of group A, but not in group B. In addition, one case fell into fatal sepsis. Based on the above findings, the interventional radiological procedure is thus considered to be the appropriate method for the prevention of infection in the case of a compromised host.
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Affiliation(s)
- T Matsuda
- Second Department of Surgery, Kyoto Prefectural University of Medicine, Japan
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10
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Gutman M, Abu-Abid S, Sorkine P, Inbar M, Lev D, Chen Z, Oron D, Chaitchik S, Klausner JM. Regional perfusion with hemofiltration (chemofiltration) for the treatment of patients with regionally advanced cancer. Cancer 1996; 78:1125-30. [PMID: 8780553 DOI: 10.1002/(sici)1097-0142(19960901)78:5<1125::aid-cncr25>3.0.co;2-3] [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: 02/02/2023]
Abstract
BACKGROUND Regionally advanced cancer is a common, often unresolved problem. Effective local control with chemotherapy is limited by the toxicity following systemic administration. Chemofiltration (CF) is a form of regional perfusion that enables the administration of cytotoxic drugs into one body area while limiting systemic toxicity. The drug is infused into the artery supplying the involved area. The venous effluent of the same organ is pumped out into a hemofiltration unit at a high flow rate. The drug is then filtered away and the blood returned to systemic circulation. METHODS Forty-one patients underwent 45 CF. Twenty-four patients had CF of the pelvis for advanced rectal carcinoma (10), malignant melanoma (6), and cancers of the uterine cervix (3), ovary (2), vulva (1), endometrium (1), and anus (1). Seventeen patients underwent CF of the liver for metastatic colon (10), breast (4), pancreas (1), ovary (1), and unknown primary (1) cancer. 5-fluorouracil (1 g/m2) and mitomycin-C (30 mg/m2); cisplatinum (200 mg/m2) alone or combined with bleomycin (50 mg/m2) and mitomycin-C (20 mg/m2); or melphalan (1 mg/kg) were the combinations used. RESULTS Generally the procedure was well tolerated. Complications included transient leukopenia (18), paralytic ileus (2), hair loss (2), renal failure (1). Two patients died within 40 days following CF. Of 36 evaluable patients, 16 (44%) had partial response, 14 (38%) had stable disease, and 6 (18%) had disease progression. A decrease of at least 30% in carcinoembryonic antigen levels occurred in 12 of 24 patients (50%). Median time to progression was 7 months. Ten of 13 patients (77%) achieved good symptomatic palliation. CONCLUSIONS The results of CF in our study are not superior to alternative methods of drug delivery to the liver and pelvis. However, considering that previous systemic chemotherapy had failed two-thirds of the patients, some benefit may be attributed to this regional delivery modality. Furthermore, pelvic CF afforded very significant symptomatic relief which was definitely superior to other methods.
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Affiliation(s)
- M Gutman
- Department of Surgery B&C, Sourasky Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, University, Israel
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Hilgenfeld RU, Kreuser ED. Immunological and biochemical modulation in the treatment of advanced colorectal cancer: update and future directions. Curr Top Microbiol Immunol 1996; 213 ( Pt 3):217-40. [PMID: 8815007 DOI: 10.1007/978-3-642-80071-9_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R U Hilgenfeld
- Medical Department I, St. Joseph Hospital, Berlin, Germany
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Hilgenfeld RU, Streit M, Thiel E, Kreuser ED. Current treatment modalities in advanced colorectal carcinoma. Recent Results Cancer Res 1996; 142:353-80. [PMID: 8893350 DOI: 10.1007/978-3-642-80035-1_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several biochemical and immunological substances are currently being tested for their efficacy in the treatment of advanced colorectal cancer, the second-most malignant disease in the western world. Presently, a combination of 5-fluorouracil (FU) and the biochemical modulator folinic acid is considered to be the standard treatment for this malignancy, with a median response rate of 30%. A recent multi-analysis of phase III trials with methotrexate and FU versus FU alone has demonstrated a statistically significant doubling of the response rate as well as a significant survival advantage for the combination. So far, other biochemical or immunological modulators of FU have not shown a significant advantage regarding response or survival. Several new drugs such as tegafur, thymidilate synthase inhibitors, trimetrexate, or topoisomerase-I-inhibitors have been tested with promising results in preclinical and early clinical settings. While local treatment such as hepatic artery infusion has become safer, it is still more toxic than systemic treatment and showed a significant improvement of response but no survival advantage. Since all treatment strategies in advanced colorectal cancer are still palliative, quality of life is a more important endpoint in clinical trials.
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Affiliation(s)
- R U Hilgenfeld
- Medical Department I, St. Joseph Hospital, Berlin, Germany
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Fujita M, Kuroda C, Hosomi N, Inoue E, Kuriyama K, Ohhigashi H, Kishimoto S, Ishikawa O, Nakaizumi A. Dye-injection method for placement of an infusion catheter in regional hepatic chemotherapy. J Vasc Interv Radiol 1995; 6:119-23. [PMID: 7703576 DOI: 10.1016/s1051-0443(95)71074-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the usefulness of a dye-injection method in the placement of an infusion catheter and port via proximal branches of the axillary artery for hepatic infusion chemotherapy. MATERIALS AND METHODS Sixteen patients with surgically unresectable hepatic cancer underwent transfemoral hepatic arteriography. Then a 3-F coaxial catheter was inserted into a proximal branch of the left axillary artery. Dye injected through the coaxial catheter during the surgical procedure improved the visualization of the target branch. The coaxial catheter was also used as a guide for retrograde insertion through the target branch of an infusion catheter into the descending aorta. RESULTS In 13 of 16 patients (81%), catheterization was successful without exposure of the axillary artery. In these patients, the acromial-deltoid branch of the thoracoacromial artery was chosen as the target. CONCLUSION Injection of dye simplifies the surgical procedure for placement of a hepatic infusion catheter via proximal branches of the axillary artery. The depth and extent of incisions, as well as the risk of nerve injury, are reduced.
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Affiliation(s)
- M Fujita
- Department of Diagnostic Radiology, Center for Adult Diseases, Osaka, Japan
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14
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Yamamoto M, Iizuka H, Fujii H, Matsuda M, Miura K. Hepatic arterial infusion of interleukin-2 in advanced hepatocellular carcinoma. Acta Oncol 1993; 32:43-51. [PMID: 8385472 DOI: 10.3109/02841869309083884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
From August 1988 to February 1991, we performed hepatic arterial cannulation after tumor mass reduction in 17 patients with advanced hepatocellular carcinoma. By a subcutaneous infusion pump the patient received a continuous infusion of interleukin-2 (IL-2) (0.35 x 10(6) Japanese Reference Unit/day) and intermittent chemoembolization with 10 mg doxorubicin emulsion. The longest period of IL-2 infusion was 32 months. In 3 patients, the IL-2 dose could not be increased to the planned level due to fever or jaundice. Eight patients received the infusion for more than 10 months. NK and LAK activity in the peripheral blood, which had been reduced after partial liver resection, arterial embolization, or ethanol injection, was enhanced significantly by the IL-2 infusion, and the levels remained high for about 8 to 10 months. During periods of high NK and LAK activity, direct effects on the liver tumors were observed. In 11 patients who received IL-2 infusion for more than 6 months there was CR in 4, PR in 2, NC in 3 and PD in 2. Thereafter, however, the levels of NK and LAK activity decreased despite increase in the IL-2 dose, and sudden appearance of metastatic tumors caused deterioration of the patients. The 1-year and 2-year cumulative survival rates were 41% and 16% respectively. Further studies are required to explore ways for longer-lasting enhancement of NK and LAK activity.
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MESH Headings
- Adult
- Aged
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/therapy
- Doxorubicin/therapeutic use
- Female
- Hepatic Artery
- Humans
- Immunotherapy
- Infusion Pumps, Implantable
- Infusions, Intra-Arterial
- Interleukin-2/administration & dosage
- Interleukin-2/adverse effects
- Killer Cells, Lymphokine-Activated/drug effects
- Killer Cells, Lymphokine-Activated/immunology
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Liver Neoplasms/drug therapy
- Liver Neoplasms/immunology
- Liver Neoplasms/mortality
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Survival Rate
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Affiliation(s)
- M Yamamoto
- Department of Surgery, Yamanashi Medical College, Japan
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15
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Riemenschneider T, Ruf C, Kratzsch HC, Ziegler M, Späth G. Arterial, portal or combined arterio-portal regional chemotherapy in experimental liver tumours? J Cancer Res Clin Oncol 1992; 118:597-600. [PMID: 1387647 DOI: 10.1007/bf01211803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The most appropriate route for regional administration of chemotherapeutic drugs to liver tumours was studied in a standardized rodent model: cells of Novikoff hepatoma were transplanted into the central liver lobe of Sprague-Dawley rats. From day 5 to day 12 after transplantation, the liver was continuously perfused with 420 mg/kg 5'-fluoro-2-deoxyuridine by subcutaneous osmotic micropumps via the hepatic artery (n = 20), the portal vein (n = 20) or both vessels together (n = 12). The tumour multiplication factor (TMF) and the vascularization of the tumour were evaluated. Arterial and combined infusion led to a highly significant reduction in TMF, but combined infusion was not more effective than arterial alone. Portal infusion had no significant effect. There was no correlation between vascularization and tumour response in arterial infusion, but a strong correlation in portal infusion. Thus chemotherapy via the portal route may be effective in selected tumours with considerable portal vascularisation.
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Affiliation(s)
- T Riemenschneider
- Department of General Surgery, Rheinische Friedrich-Wilhelms-Universität, Bonn-Venusberg, Federal Republic of Germany
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Damascelli B, Bonalumi MG, Marchianò A, Spreafico C, Garbagnati F, Amadeo A, Salvetti M, Frigerio LF, Piragine G, Cesa Bianchi A. Continuous infusion with implantable pumps: expanding the radiologist's role. Eur J Radiol 1991; 12:191-4. [PMID: 1906807 DOI: 10.1016/0720-048x(91)90071-3] [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: 12/29/2022]
Abstract
Drug infusion systems attract increasing attention as biomedical technology offers miniaturized devices for targeted delivery of therapeutic substances on an outpatient basis. We have used a totally implantable, subcutaneous pump, externally programmable by radiofrequency link, learning the technique of implantation and management and using various imaging modalities for the diagnosis and control of complications. The procedure for implanting systems for continuous intrathecal analgesia and systemic intravenous chemotherapy is described. Our experience of the latter is made up of 296 implants in 290 patients. The selected infusion pump proved reliable and acceptable to patients and the quality of life, given the reduced drug toxicity, more than good. The complications were few both in frequency and in severity. The setting-up of a long-term infusion system, when major surgery is not needed, can fall within the interventional radiologist's field, partly because of a good cost-benefit ratio.
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Affiliation(s)
- B Damascelli
- Dept. of Interventional Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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Cosimelli M, Mannella E, Anzá M, Civalleri D, Balletto N, Di Tora P, Durante F, Porcellana M, Cavaliere P, Anfossi A. Two consecutive clinical trials on cisplatin (CDDP), hepatic arterial infusion (HAI), and i.v. 5-fluorouracil (5-FU) chemotherapy for unresectable colorectal liver metastases: an alternative to FUdR-based regimens? JOURNAL OF SURGICAL ONCOLOGY. SUPPLEMENT 1991; 2:63-8. [PMID: 1832541 DOI: 10.1002/jso.2930480515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Waugh RC, Stephens FO. Indications for surgical or radiological placement of cannulas for intra-arterial induction chemotherapy. AUSTRALASIAN RADIOLOGY 1990; 34:196-9. [PMID: 2275674 DOI: 10.1111/j.1440-1673.1990.tb02630.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intra-arterial chemotherapy achieves a higher concentration and increased total dose of drugs to a locally advanced cancer. This principle is increasingly being applied for pretreatment of advanced or aggressive localised tumours to make them more curable by subsequent radiotherapy. This is sometimes called "neo-adjuvant" chemotherapy but better called INDUCTION chemotherapy (Stephens 1989).
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Affiliation(s)
- R C Waugh
- Royal Prince Alfred Hospital, Camperdown, Australia
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19
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Williams NN, Daly JM. Infusional versus systemic chemotherapy for liver metastases from colorectal cancer. Surg Clin North Am 1989; 69:401-10. [PMID: 2522683 DOI: 10.1016/s0039-6109(16)44795-x] [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: 01/01/2023]
Abstract
It is clear from these studies that intrahepatic arterial infusion of floxuridine produces significantly higher response rates than does systemic infusion of the same drugs. Nevertheless, survival is the most important consideration when comparing two methods of treatment, and at present, there is only a slightly improved survival rate in those patients who receive intrahepatic infusional therapy. However, palliation of the patient and the effect on the quality of life should be taken into account, and these high response rates suggest an effective palliative measure to be offered to patients with this advanced disease. It is hoped that in the future the development of methods to identify those patients who will respond to this form of therapy, together with new ways to increase drug uptake by the tumors, will translate the better response rates achieved into better survival rates.
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20
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Affiliation(s)
- T G Allen-Mersh
- Department of Surgery, Charing Cross and Westminster Medical School, London
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21
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Schlag P, Herfarth C. Liver Infusion Chemotherapy. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Continuous or bolus chemotherapy with 5-fluoro-2'-deoxyuridine in transplanted experimental liver tumors? J Cancer Res Clin Oncol 1988; 114:482-6. [PMID: 2972727 DOI: 10.1007/bf00391496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of continuous and discontinuous locoregional chemotherapy with Floxuridine (FUdR) was studied in a standardized and controlled animal model, using the transplantable Novikoff hepatoma in Sprague-Dawley rats. The liver was perfused after transplantation with a total of 420 mg/kg FUdR, via a fully implanted osmotic minipump or miniport and catheter in the hepatic artery, either continuously (n = 22) from day 5 to day 12, or discontinuously (n = 28) on days 5 and 8. Viable tumor volume and peritumorous cell infiltration were measured. No reduction in tumor volume was attained using discontinuous therapy, in contrast to a highly significant reduction using continuous therapy (P less than 0.001). Significantly less cell infiltration was found after discontinuous than after continuous therapy. In conclusion, continuous locoregional chemotherapy with FUdR was the superior administration method on measurable tumor effect, when compared to discontinuous infusion.
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23
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Cherqui D, Garden OJ, Bismuth H. Duodenal erosion complicating an implanted hepatic arterial access device. Br J Surg 1988; 75:556. [PMID: 3395822 DOI: 10.1002/bjs.1800750617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- D Cherqui
- Unite de Chirurgie Hepato-Biliaire, Hôpital Paul Brousse, Villejuif, France
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24
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Rettenmaier MA, Moran MF, Ramsinghani NF, Colman M, Syed NA, Puthawala A, Jansen FW, DiSaia PJ. Treatment of advanced and recurrent squamous carcinoma of the uterine cervix with constant intraarterial infusion of cisplatin. Cancer 1988; 61:1301-3. [PMID: 3345485 DOI: 10.1002/1097-0142(19880401)61:7<1301::aid-cncr2820610704>3.0.co;2-u] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Twelve patients with primary or locally recurrent squamous carcinoma of the cervix were treated with constant internal iliac artery infusion of cisplatin (CDDP) via a totally implantable chemotherapy pump. Seven previously untreated patients received standard external and interstitial radiotherapy (RT) in conjunction with CDDP infusion. Five patients with isolated pelvic recurrences received CDDP therapy only. The chemotherapy pump was refilled weekly on an outpatient basis. All nine evaluable patients developed unilateral or bilateral lower extremity pain which responded to dosage reduction. No renal or marrow toxicity was seen. Both of the evaluable patients treated for recurrent tumor died 32 and 60 weeks after initiation of treatment. The seven patients treated primarily with RT + CDDP infusion include one who expired with persistent tumor and one with no evidence of disease (NED) after exenteration for a pelvic recurrence at 48 and 85 weeks respectively. The five remaining patients are NED at 12 to 60 weeks. Constant internal iliac artery infusion of CDDP via an implantable chemotherapy pump can be performed with acceptable toxicity. The preliminary results suggest that further study in previously untreated undergoing concurrent radiotherapy is warranted.
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Affiliation(s)
- M A Rettenmaier
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange 92668
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25
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Janis LW, Leming PD, Leder W. Nonspecific corticosteroid therapy in patients receiving intra-arterial chemotherapy for hepatic metastases of colorectal origin. Cancer Invest 1988; 6:267-70. [PMID: 2971425 DOI: 10.3109/07357908809080648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cholestatic jaundice induced by hepatic intra-arterial 5-fluorodeoxyuridine (FUDR) demonstrated marked improvement in three patients following treatment with oral corticosteroids. Subsequent "prophylactic" use allowed continuation of chemotherapy and improved quality of life. Corticosteroid use in selected patients with FUDR-induced cholestatic jaundice may be beneficial.
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Affiliation(s)
- L W Janis
- University of Cincinnati School of Medicine, Ohio
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26
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Flowerdew A, Taylor I. Approach of the treatment of colorectal liver metastases. Recent Results Cancer Res 1988; 110:150-63. [PMID: 3043590 DOI: 10.1007/978-3-642-83293-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A Flowerdew
- Winchester Health Authority, Royal Hampshire County Hospital, Great Britian
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27
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Gaskill HV. Intraportal prostaglandin E1 ameliorates the toxicity of intraportal 2'-deoxy-5-fluorouridine in rats. J Surg Res 1987; 43:128-32. [PMID: 2957549 DOI: 10.1016/0022-4804(87)90154-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study was designed to see whether intraportal infusion with prostaglandin E1 (PGE1) could reduce mortality associated with high-dose intraportal infusion of 2'-deoxy-5-fluorouridine (FUDR). Thirty anesthetized male Sprague-Dawley rats underwent laparotomy and placement of osmotic pumps (Alzet 2ML1) infusing a branch of the portal vein. Animals were weighed and infused for 1 week with buffer (control), FUDR (3 mg/kg/day), or FUDR (3 mg/kg/day) + PGE1 (0.1 microgram/kg/min). Blood was then obtained for liver functions and white blood cell count. The body and liver were weighed. No animals died in the control group. Five animals in the FUDR group died during the fourth (n = 1), sixth (n = 2), and seventh (n = 2) days of infusion. Only one animal in FUDR + PGE1 group died during the sixth day of infusion. Weight loss was greater in both treated groups than in controls. Animals receiving PGE1 lost significantly less weight than animals receiving FUDR alone. These data suggest that intraportal PGE1 ameliorates the hepatic toxicity of intraportal FUDR. The effect of PGE1 on the tumoricidal properties of FUDR infused by either the portal vein or the hepatic artery remains to be studied.
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28
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Balch CM, Levin B. Regional and systemic chemotherapy for colorectal metastases to the liver. World J Surg 1987; 11:521-6. [PMID: 2957860 DOI: 10.1007/bf01655818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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29
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30
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Thom AK, Sigurdson ER, Ridge JA, Zhang SZ, Daly JM. Modulation of doxorubicin uptake by epinephrine in the VX-2 carcinoma. J Surg Res 1987; 42:543-9. [PMID: 3586624 DOI: 10.1016/0022-4804(87)90030-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of regional chemotherapy is to deliver maximal drug concentrations to localized unresectable tumors, to minimize systemic toxicity, and to improve tumor response to treatment. Manipulation of regional blood flow by vasoactive agents could further increase tumor drug levels. This study evaluates the effect of hepatic artery infusion of epinephrine on tumor and liver doxorubicin uptake. New Zealand White rabbits (n = 17) were implanted with hepatic VX-2 carcinomas which were allowed to grow to 2-3 cm in diameter. Doxorubicin (3 mg/kg) +/- [14C]doxorubicin (2.5 microCi) was given alone (controls) or following low- (5 micrograms) or high- (15-50 micrograms) dose epinephrine infusion into the hepatic artery. Heart, liver, and tumor were obtained 30 min after infusion for determination of doxorubicin concentration. The doxorubicin liver concentrations were similar in all three groups but tumor levels decreased from 26.6 +/- 16.3 to 6.7 +/- 2.8 and 6.6 +/- 4.3 nmole/g in the epinephrine groups. Myocardial levels were reduced by the high-dose epinephrine (6.8 +/- 2.2 nmole/g) when compared to controls (11.3 +/- 2.1 nmole/g) or low-dose epinephrine (11.5 +/- 1.8 nmole/g). The liver concentration of doxorubicin was not significantly affected by intraarterial epinephrine. The myocardial doxorubicin concentration was affected only by epinephrine doses sufficient to cause severe systemic vasoconstriction. The decrease in tumor doxorubicin concentration to low-dose (5 micrograms) and high-dose (15-50 micrograms) epinephrine suggests that intraarterial epinephrine limits doxorubicin uptake by tumor.
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31
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Lind J, Bush NJ. Nursing's role in chemotherapy administration. Semin Oncol Nurs 1987; 3:83-6. [PMID: 3554431 DOI: 10.1016/0749-2081(87)90027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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32
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Kerr DJ. Microparticulate drug delivery systems as an adjunct to cancer treatment. CANCER DRUG DELIVERY 1987; 4:55-61. [PMID: 3300944 DOI: 10.1089/cdd.1987.4.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In an attempt to improve the therapeutic ratio of cytotoxic drugs, which have steep dose-response curves, microparticulate drug delivery systems (MDDS) have been designed for regional administration. Introduction of antineoplastic drug containing microspheres, of appropriate size, into the arterial system of an organ harboring primary or metastatic tumor, will cause tumor infarction by an embolic effect and provide a slow release source of drug trapped within the tumor microvasculature. This review describes recent innovations in synthesis of MDDS and their potential clinical application.
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33
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Kemeny N. Role of chemotherapy in the treatment of colorectal carcinoma. SEMINARS IN SURGICAL ONCOLOGY 1987; 3:190-214. [PMID: 3310182 DOI: 10.1002/ssu.2980030312] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Large bowel cancer afflicts more patients in the United States than any other malignancy excluding skin cancer. Fifty percent of patients who undergo resection of colorectal carcinoma have positive lymph nodes, and approximately 18% have liver metastases at initial presentation. To improve survival, more effective treatment than surgical resection of the primary must be developed. The most active single agent in the treatment of colorectal carcinoma is 5-fluorouracil (5-FU). To increase the response rate obtained with this agent, work has been done on the modulation of 5-FU by other agents, using drugs that are synergistic with 5-FU and manipulating the method of 5-FU administration. Combination chemotherapy has improved response rates in some situations, though generally it has not been shown to improve survival. Studies using direct hepatic infusion clearly demonstrate an increase in response rates, but again, it is too early to say whether this type of treatment increases survival. Early adjuvant chemotherapy trials used inadequate doses of chemotherapy for short periods of time and demonstrated no added efficacy to surgery alone. Later studies with more aggressive therapy suggested some benefit to treating patients with rectal carcinoma; however, there is still little evidence that adjuvant chemotherapy improves survival in patients with colon carcinoma. To compare and understand the various chemotherapy trials, more stringent reporting of baseline laboratory values, performance status, and estimation of tumor involvement are needed.
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Affiliation(s)
- N Kemeny
- Memorial Sloan-Kettering Cancer Center, New York
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34
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Civalleri D, Scopinaro G, Simoni G, Claudiani F, Repetto M, DeCian F, Bonalumi U. Starch microsphere-induced arterial flow redistribution after occlusion of replaced hepatic arteries in patients with liver metastases. Cancer 1986; 58:2151-5. [PMID: 3756831 DOI: 10.1002/1097-0142(19861101)58:9<2151::aid-cncr2820580932>3.0.co;2-f] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In four patients with major anomalies of the hepatic artery undergoing intra-arterial chemotherapy, aberrant lobar vessels were ligated and catheters were inserted into the contralateral artery. Catheter perfusion scans performed early after ligation with 99mTc-macroaggregated albumin (MAA) showed a defective perfusion of the lobe supplied by the occluded artery (0.43, 0.23, 0.11, and 0.28, respectively, as compared to the contralateral lobe). Further MAA scans performed after catheter infusion of 90,000,000 parts of degradable starch microspheres (DSM) showed a near normal perfusion of the ischemic lobe (0.91, 0.96, 0.87, and 0.98). On the contrary, simple MAA scans performed in the first two patients 114 and 135 days after ligation showed a still defective arterial perfusion of the ischemic lobe (0.60, and 0.24). The DSM-induced redistribution of flow towards ischemic portions of the liver suggests a possible new role of DSM in regional treatment of liver tumors in cases with either occlusion of aberrant vessels or "hypovascular" tumors.
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35
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Abstract
The authors reviewed the liver histopathology and the clinical features of eight patients with liver metastases from colorectal cancer who were treated by hepatic arterial infusion chemotherapy (HAIC) via an implantable pump (Infusaid). Before HAIC, these patients had no evidence of hepatitis, and results of liver biopsies performed on three patients showed only minor morphologic alterations. All the liver tumors responded to HAIC, but all patients developed hepatitis. Clinical findings included nausea, vomiting, abdominal pain and jaundice. Serum transaminases, alkaline phosphatase and bilirubin levels were increased. Clinical observations suggested that 5-fluoro-2'-deoxyuridine (FUDR), the predominant drug given, was the hepatotoxic agent. Toxic effects were hepatocyte necrosis, steatosis, cholestasis, central vein sclerosis, and alterations in the portal triad. In addition, central vein lesions like those in veno-occlusive disease, and micronodular cirrhosis resembling that induced by alcohol, were encountered. Although individual susceptibility to FUDR appeared to vary, portal triad fibrosis was present in all eight cases and, together with central vein sclerosis and cirrhosis, appeared to be related to the dose and duration of HAIC.
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36
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Haq MM, Valdes LG, Peterson DF, Gourley WK. Fibrosis of extrahepatic biliary system after continuous hepatic artery infusion of floxuridine through an implantable pump (Infusaid pump). Cancer 1986; 57:1281-3. [PMID: 2936442 DOI: 10.1002/1097-0142(19860401)57:7<1281::aid-cncr2820570704>3.0.co;2-b] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of severe fibrosis of the extrahepatic biliary system after hepatic artery infusion of floxuridine is described. The clinical and pathologic features are presented, and its pathogenesis discussed. The authors suggest investigation of an alternate drug schedule and/or dosage of floxuridine to eliminate or minimize this serious complication.
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37
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Gerard A, Dalesio O, Duez N, Lise M, Pector JC, Bleiberg H, Nitti D, Willems G, Delvaux G. Hepatic arterial ligation and portal vein infusion: a clinical trial by the Gastrointestinal Tract Cancer Group of the European Organization for Research and Treatment of Cancer. Recent Results Cancer Res 1986; 100:276-81. [PMID: 3526468 DOI: 10.1007/978-3-642-82635-1_34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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38
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Balch CM, Urist MM. Intraarterial chemotherapy for colorectal liver metastases and hepatomas using a totally implantable drug infusion pump. Recent Results Cancer Res 1986; 100:234-47. [PMID: 3016842 DOI: 10.1007/978-3-642-82635-1_30] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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39
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Stephens FO, Crea P, Walker PJ. The implantable “Infusaid” infusion pump: The Sydney experience using 5‐fluorouracil. Med J Aust 1986. [DOI: 10.5694/j.1326-5377.1986.tb113663.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Frederick O. Stephens
- Royal Prince Alfred Hospital Missenden Road Camperdown NSW 2050
- Sydney Hospital, The University of Sydney, Royal Prince Alfred Hospital
| | - Paul Crea
- St Vincent's Hospital Darlinghurst NSW 2010
- Sydney Hospital
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40
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Gluck WL, Akwari OE, Kelvin FM, Goodwin BJ. A reversible enteropathy complicating continuous hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine. Cancer 1985; 56:2424-7. [PMID: 2931170 DOI: 10.1002/1097-0142(19851115)56:10<2424::aid-cncr2820561015>3.0.co;2-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article describes two patients with hepatic metastases from colorectal cancer in whom a reversible enteropathy developed during the administration of hepatic artery infusion chemotherapy with 5-fluoro-2-deoxyuridine (5-FUdR) via an Infusaid Series 400 pump (Infusaid Corp., Sharon, MA). Both patients had severe diarrhea and signs that suggested small bowel obstruction. Barium studies revealed a distinctive radiologic appearance of severe narrowing of the ileum associated with complete loss of normal mucosal patterns. Results of an extensive evaluation for an infectious or toxin-related enterocolitis were negative. Perfusion studies confirmed the appropriate position of the catheters and revealed no extrahepatic perfusion. Systemic shunting of the 5-FUdR through the liver or tumor bed is postulated as the primary event, with the small bowel manifesting the major toxicity.
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41
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Kemeny MM, Battifora H, Blayney DW, Cecchi G, Goldberg DA, Leong LA, Margolin KA, Terz JJ. Sclerosing cholangitis after continuous hepatic artery infusion of FUDR. Ann Surg 1985; 202:176-81. [PMID: 3160313 PMCID: PMC1250871 DOI: 10.1097/00000658-198508000-00007] [Citation(s) in RCA: 114] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eight of 46 (17.4%) patients treated in our trial of continuous hepatic artery infusion (CHAI) of fluorodeoxyuridine (FUDR) by Infusaid pump developed biliary strictures. The lesions were clinically, radiographically, and pathologically identical to the idiopathic sclerosing cholangitis frequently seen in association with inflammatory bowel disease. Treatment included immediate cessation of intraarterial FUDR, and surgical or percutaneous drainage of the biliary tree if it was dilated. Two of the eight patients died of the complication. Three patients stabilized after biliary system drainage, and two patients improved on observation only. The pathogenesis of this complication is not understood. This report details the clinical and pathological features of this entity.
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42
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Civalleri D, Scopinaro G, Simoni G, Claudiani F, Repetto M, De Cian F. Intrahepatic Arterial flow Distribution after Ligation of A Right Replaced Hepatic Artery. A Case Report. TUMORI JOURNAL 1985; 71:375-7. [PMID: 4049540 DOI: 10.1177/030089168507100410] [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: 11/15/2022]
Abstract
A basic requirement for arterial chemotherapy of liver tumors is complete catheter perfusion of the liver. In cases with atypical anatomy of the hepatic artery, it is frequently impossible to obtain this goal by means of a single catheter. In a patient with a right replaced hepatic artery, the aberrant vessel was ligated and the left hepatic artery was perfused through a catheter inserted into the gastroduodenal artery. Perfusion scans performed through the catheter 14 and 135 days after arterial ligation showed a fall in the arterial flow to the right liver (right/left ratio 0.43 and 0.60). In contrast, a nearly complete perfusion of the liver (0.91 right/left ratio) was obtained 28 days after ligation, when the perfusion scan was performed immediately after catheter infusion of 90,000,000 degradable starch microspheres (DSM: diameter = 40 m). DSM administration is supposed to increase back pressure in the lobe receiving native circulation, thus activating intrahepatic collateral flow to the ischemic lobe. As regards regional treatment of liver tumors, obvious conclusions are to be drawn.
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43
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44
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Harbaugh RE, Reeder TM. Continuous drug delivery by an implantable pump. THE AMERICAN JOURNAL OF HOSPICE CARE 1985; 1:17-20. [PMID: 10315655 DOI: 10.1177/104990918400100215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous infusion of drugs via an implantable infusion system offers advantages that are not available with other methods of drug delivery. For patients who require frequent drug injections, a continuous drug level, or high local concentrations, an implantable pump may assure compliance, comfort, and an improved therapeutic response. This method of drug delivery has been shown to be reliable and well tolerated by patients in numerous clinical trials. For hospice care professionals, familiarity with the mechanism of drug delivery and the various approved and experimental uses of the implantable pump will in all likelihood become increasingly important. At the present time regional infusion chemotherapy and intraspinal narcotic infusion for cancer pain seem to be most frequently encountered in a hospice setting. However, other uses for these implantable infusion systems are rapidly being developed, and this means of drug delivery probably will become more common in the next few years. One of the goals of continuous drug infusion by implantable pumps--optimal medical care without confining the patient to a hospital bed--is eminently compatible with the philosophy of hospice care.
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45
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Oliver GC, Shorb PE. The totally implantable infusion pump in treatment of metastatic colorectal cancer. Dis Colon Rectum 1985; 28:18-23. [PMID: 3971795 DOI: 10.1007/bf02553900] [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: 02/08/2023]
Abstract
Final evaluation of the Infusaid Pump system (Infusaid Corporation, Sharon, MA) for administration of regional chemotherapy must await completion of trials prospectively comparing survival of matched patients treated in this manner and patients treated by traditional systemic chemotherapy. A review of the current medical literature confirms our personal experience that response rates within the liver are high. Survival reports appear encouraging but this may represent an artifact in patient selection. An algorithm is presented to offer surgeons a reasonable and conservative means for selection of those colorectal cancer patients with metastatic involvement of the liver who are most likely to benefit from this system of drug delivery.
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46
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47
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Abstract
Technical advances that have provided reliable long-term vascular access are described in the setting of pulse and continuous venous chemotherapy infusion and for regional arterial drug delivery. Despite dramatic improvement in the morbidity of such access procedures, it is important to remember that their value still depends upon the effectiveness of the chemotherapy delivered.
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48
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Abstract
Ninety-three patients with biopsy-proven colorectal cancer metastatic to the liver were treated with hepatic arterial infusion of 5-fluorodeoxyuridine (FUDR). There were 52 men and 41 women (median age, 60 years). Forty-two patients (45%) had failed prior systemic chemotherapy. Catheters were operatively placed and multiple catheters were used if dictated by hepatic arterial anatomy in order to obtain perfusion of the entire liver. The drug was delivered by a totally implanted INFUSAID model 400 pump and patients received cyclic therapy consisting of 2 weeks of 0.3 mg/kg/d FUDR alternating with 2 weeks of saline. Patients with extrahepatic tumor or patients whose hepatic tumor failed to respond to FUDR were given a 30 minute intraarterial infusion of mitomycin C, 15 mg/m2, every 6 to 8 weeks in addition to FUDR. Fifty of the 93 evaluable patients presented with metastatic tumor confined to the liver. Of these 50 patients, 83% demonstrated a significant reduction in tumor size with a median duration of response of 13 months and a median survival of 25 months from diagnosis of liver metastases. Twenty-four of these 50 patients remain alive. Forty-three patients presented with extrahepatic metastases in addition to their liver tumor, and 74% had a response with a median duration of 6 months and a median survival of 14 months. Only six patients of those presenting with extrahepatic tumor remain alive. None of the 93 patients died solely of uncontrolled liver tumor, and only 9 died as a result of uncontrolled liver metastases and disseminated extrahepatic tumor. The duration of survival for both groups was determined by the uncontrolled progression of extrahepatic tumor. In patients with metastatic colorectal cancer involving only the liver, hepatic arterial FUDR alone and with the addition of mitomycin C provided excellent control of hepatic tumor. Survival appeared to be prolonged in this uncontrolled study.
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49
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Balch CM, Urist MM, Soong SJ, McGregor M. A prospective phase II clinical trial of continuous FUDR regional chemotherapy for colorectal metastases to the liver using a totally implantable drug infusion pump. Ann Surg 1983; 198:567-73. [PMID: 6227295 PMCID: PMC1353125 DOI: 10.1097/00000658-198311000-00001] [Citation(s) in RCA: 169] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A prospective phase II evaluation of regional FUDR chemotherapy using a totally implantable drug infusion pump was conducted in 81 patients with colorectal metastases to the liver. The survival results were compared to a historical control group of 129 patients with isolated liver metastases. The two groups were comparable with respect to their dominant prognostic factors. The pump patients received their continuous chemotherapy on an outpatient basis and had an 88% response rate, as evidenced by a fall in their serum CEA levels by one-third or greater after two cycles of chemotherapy. By four criteria, the regional chemotherapy patients had an improved survival rate compared to the control series. First, the 1 year survival and median survival was better for the entire group of pump patients vs. controls (82% vs. 36%, 26 months vs. 8 months, p less than 0.0001). The survival for the regional chemotherapy patients was not influenced by the extent of tumor involvement, whether previous systemic 5-FU was given, or whether the patient had symptomatic disease. Second, the entire group of regional chemotherapy patients (including nonresponders) had a greater 1 year survival compared to the most favorable subgroup of control patients with the following characteristics: normal liver function tests, no symptoms, and only one lobe involved (82% vs. 66%, p = 0.009). Third, a subgroup of 49 pump patients, whose initial treatment for metastatic disease was regional chemotherapy (within 3 months of diagnosis) had a better 1 year survival than an exactly matched group of 49 control patients (67% vs. 30%, p = 0.000003). Fourth, the actuarial survival for all 81 pump patients was significantly better than predicted by a mathematical model constructed to predict the patient's clinical course based upon the seven dominant prognostic variables identified in a multifactorial analysis (82% survival at 1 year vs. 33% predicted survival). While liver metastases could be controlled in most patients, the major cause of death was tumor progression in extrahepatic sites, particularly lung metastases and abdominal carcinomatosis. Although it appears that regional chemotherapy with an implantable pump appears to prolong life by 12 to 18 months more than matched historical controls, these results must be confirmed by a randomized (phase III) prospective clinical trial.
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Brozenec SA. Surgical implants. Medication & alimentation devices. AORN J 1983; 37:1353, 1356-68. [PMID: 6408982 DOI: 10.1016/s0001-2092(07)64982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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