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Sneiders D, Boteon APCS, Lerut J, Iesari S, Gilbo N, Blasi F, Larghi Laureiro Z, Orlacchio A, Tisone G, Lai Q, Pirenne J, Polak WG, Perera MTPR, Manzia TM, Hartog H. Transarterial chemoembolization of hepatocellular carcinoma before liver transplantation and risk of post-transplant vascular complications: a multicentre observational cohort and propensity score-matched analysis. Br J Surg 2021; 108:1323-1331. [PMID: 34611694 DOI: 10.1093/bjs/znab268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) in patients with hepatocellular cancer (HCC) on the waiting list for liver transplantation may be associated with an increased risk for hepatic artery complications. The present study aims to assess the risk for, primarily, intraoperative technical hepatic artery problems and, secondarily, postoperative hepatic artery complications encountered in patients who received TACE before liver transplantation. METHODS Available data from HCC liver transplantation recipients across six European centres from January 2007 to December 2018 were analysed in a 1 : 1 propensity score-matched cohort (TACE versus no TACE). Incidences of intraoperative hepatic artery interventions and postoperative hepatic artery complications were compared. RESULTS Data on postoperative hepatic artery complications were available in all 876 patients (425 patients with TACE and 451 patients without TACE). Fifty-eight (6.6 per cent) patients experienced postoperative hepatic artery complications. In total 253 patients who had undergone TACE could be matched to controls. In the matched cohort TACE was not associated with a composite of hepatic artery complications (OR 1.73, 95 per cent c.i. 0.82 to 3.63, P = 0.149). Data on intraoperative hepatic artery interventions were available in 825 patients (422 patients with TACE and 403 without TACE). Intraoperative hepatic artery interventions were necessary in 69 (8.4 per cent) patients. In the matched cohort TACE was not associated with an increased incidence of intraoperative hepatic artery interventions (OR 0.94, 95 per cent c.i. 0.49 to 1.83, P = 0.870). CONCLUSION In otherwise matched patients with HCC intended for liver transplantation, TACE treatment before transplantation was not associated with higher risk of technical vascular issues or hepatic artery complications.
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Affiliation(s)
- D Sneiders
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A P C S Boteon
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Lerut
- Institute for Experimental and Clinical Research (IREC), Université catholique de Louvain UCL, Brussels, Belgium
| | - S Iesari
- Institute for Experimental and Clinical Research (IREC), Université catholique de Louvain UCL, Brussels, Belgium.,Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - N Gilbo
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Surgery Science, Diagnostic and Interventional Unit, University Hospital Tor Vergata, Rome, Italy
| | - F Blasi
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Z Larghi Laureiro
- Department of Surgery Science, Transplantation and HPB Unit, University Hospital Tor Vergata, Rome, Italy
| | - A Orlacchio
- General Surgery and Organ Transplant Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Policlinic of Rome, Rome, Italy
| | - G Tisone
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Q Lai
- Department of Surgery Science, Transplantation and HPB Unit, University Hospital Tor Vergata, Rome, Italy
| | - J Pirenne
- Department of Surgery Science, Diagnostic and Interventional Unit, University Hospital Tor Vergata, Rome, Italy
| | - W G Polak
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M T P R Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - T M Manzia
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - H Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Gilbo N, Van Praet L, Jochmans I, Sainz-Barriga M, Verslype C, Maleux G, Laleman W, van der Merwe S, Cassiman D, Nevens F, Monbaliu D, Pirenne J. Pre-operative trans-catheter arterial chemo-embolization increases hepatic artery thrombosis after liver transplantation - a retrospective study. Transpl Int 2017; 31:71-81. [DOI: 10.1111/tri.13046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Nicholas Gilbo
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Laura Van Praet
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
| | - Ina Jochmans
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Mauricio Sainz-Barriga
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Geert Maleux
- Department of Radiology; KU Leuven; Leuven Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | | | - David Cassiman
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology; KU Leuven; Leuven Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; Laboratory of Abdominal Transplant Surgery; KU Leuven; Leuven Belgium
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Abstract
Clinical pharmacology may be defined as the branch of medicine concerned with the therapeutic agents used in the prevention, treatment, and control of disease. Pharmaceuticals are the specific agents used to combat disease. Hence, many of the agents used by the interventionalist may be considered pharmaceuticals. Safe and effective use of these therapeutics requires understanding of vascular anatomy and disease pathology, proper technique, and knowledge of the therapeutic agents. This article reviews many of the agents available and some that are on the horizon. The future of transarterial therapies is bright and holds many promises.
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Affiliation(s)
- Aalpen A Patel
- Department of Radiology, Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Daniels JR, Wallman M. Subselective Intra-arterial Chemotherapy Infusion in the Treatment of Hepatocellular Carcinoma. Semin Oncol 2010; 37:83-8. [DOI: 10.1053/j.seminoncol.2010.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Triple-drug transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: assessment of survival in 124 consecutive patients. AJR Am J Roentgenol 2010; 193:1665-71. [PMID: 19933662 DOI: 10.2214/ajr.08.1806] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of our study was to describe survival outcome in 124 patients with unresectable hepatocellular carcinoma treated with triple-drug transcatheter arterial chemoembolization (TACE) using doxorubicin, cisplatin, and mitomycin C using a standardized regimen. MATERIALS AND METHODS One hundred twenty-four patients underwent TACE using a standardized triple-drug regimen. Embolization was performed using subselective coaxial embolization technique. Fifty-six patients (group 1) received triple-drug TACE in conjunction with a nonpermanent embolic agent, microfibrillar collagen (Avitene), and 68 patients (group 2) had triple-drug TACE with a permanent embolic agent, Embosphere Microspheres. RESULTS Twenty-eight patients underwent liver transplantation after TACE, and survival in these patients was significantly longer than those who did not receive a transplant (p < or = 0.001). The mean survival for the no-transplant group (n = 96) was longer in patients with Child-Pugh class A cirrhosis than in those with Child-Pugh class B cirrhosis (30.3 +/- 2.92 [standard error] vs 11.6 +/- 2.84 months, respectively; p < 0.001), in those with Okuda stage I versus stage II disease (31.4 +/- 3.03 vs 17.4 +/- 3.16 months; p = 0.002), and in those with a pre-TACE bilirubin level of less than 2.5 mg/dL (42.75 micromol/L; 28.3 +/- 2.75 vs 13.2 +/- 3.83 months; p = 0.007). Improved survival was seen in the no-transplant patients receiving TACE with the permanent embolic agent (group 2) than in those receiving TACE with the nonpermanent agent (group 1) out to 30 months (p = 0.002). Complications occurred in 16 patients (12.9%). The 30-day mortality was 2.4%. CONCLUSION Patients with hepatocellular carcinoma who underwent triple-drug TACE followed by liver transplantation showed the longest survival. Patients who did not receive a transplant and were treated with triple-drug TACE with a permanent embolic agent showed longer survival to 30 months after TACE than those receiving a nonpermanent embolic agent.
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Embolization 2003: Techniques and Equipment—A Personal Selection and Some Caveats. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Richard HM, Silberzweig JE, Mitty HA, Lou WY, Ahn J, Cooper JM. Hepatic arterial complications in liver transplant recipients treated with pretransplantation chemoembolization for hepatocellular carcinoma. Radiology 2000; 214:775-9. [PMID: 10715045 DOI: 10.1148/radiology.214.3.r00mr31775] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the prevalence of hepatic arterial complications in patients who underwent hepatic arterial chemoembolization for hepatocellular carcinomas before orthotopic liver transplantation with the prevalence of hepatic arterial complications in the total population of liver transplant recipients. MATERIALS AND METHODS Forty-seven patients underwent selective hepatic arterial chemoinfusion with mitomycin C, doxorubicin hydrochloride, and cisplatin combined with embolization. The prevalence rates for hepatic arterial complications, including pseudoaneurysm, stenosis, anastomotic disruption, and thrombosis, were tabulated and compared with results in 1,154 patients who underwent orthotopic liver transplantation but not chemoembolization. RESULTS Of the 47 patients who had undergone preoperative hepatic arterial chemotherapy, 13% developed hepatic arterial complications within a mean of 7 days after transplantation; an 8% prevalence of hepatic arterial thrombosis was observed. Of the 1,154 patients who underwent orthotopic liver transplantation but not chemotherapy, 6% developed hepatic arterial complications; a 5% prevalence of hepatic arterial thrombosis was observed. There was no statistically significant difference in the prevalence rates for thrombosis and complications between the patients who underwent chemoembolization before orthotopic liver transplantation and those who did not. The mean interval between chemotherapy and orthotopic liver transplantation was 111 days (range, 3-428 days). CONCLUSION Patients who undergo hepatic arterial chemotherapy are not at an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after orthotopic liver transplantation.
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Affiliation(s)
- H M Richard
- Department of Radiology, Mount Sinai Hospital, New York, NY, USA.
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Leichman CG, Jacobson JR, Modiano M, Daniels JR, Zalupski MM, Doroshow JH, Fletcher WS, Macdonald JS. Hepatic chemoembolization combined with systemic infusion of 5-fluorouracil and bolus leucovorin for patients with metastatic colorectal carcinoma. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990901)86:5<775::aid-cncr12>3.0.co;2-m] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Koda Y, Kan Z, Wallace S, Kaminou T, Nakamura K, Yamada R. Hepatic microcirculatory changes induced by hepatic artery embolization in rats: original investigation. Invest Radiol 1999; 34:160-6. [PMID: 9951797 DOI: 10.1097/00004424-199902000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the effects of hepatic artery embolization (HAE), hepatic microcirculatory changes induced by HAE were assessed quantitatively in rats. METHODS Using in vivo microscopy, the blood-flow velocity (BFV) through terminal portal venules (TPVs) and terminal hepatic venules (THVs) was measured during HAE with gelatin sponge powder (GSP), iodized oil (Lipiodol, 0.1, 0.2, and 0.4 mL/kg), or 0.1 mL/kg Lipiodol followed by GSP. RESULTS After HAE with GSP, BFV through TPVs decreased significantly, but BFV through THVs did not decrease. After HAE with Lipiodol (0.2 and 0.4 mL/kg), BFV through TPVs decreased significantly, but BFV through THVs did not. After HAE with Lipiodol followed by GSP, BFV through both TPVs and THVs decreased significantly. CONCLUSIONS Neither GSP nor Lipiodol adversely affects hepatic microcirculation when administered alone; however, HAE with a combination of Lipiodol and GSP does adversely affect hepatic microcirculation.
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Affiliation(s)
- Y Koda
- Department of Radiology, Osaka City University Medical School, Osaka, Japan
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Abstract
Intra-arterial infusion includes a variety of treatment modalities, adjusted selectively to chemosensitivity and vascularization. For most drugs, response behaviour of different tumors is concentration dependent and requires improved modes of application of cytotoxics. In the treatment of liver metastases from colorectal cancer and hepatocellular carcinoma, blood flow reduction by micro-embolization with starch microspheres has brought significant advantage in response. Balloon stopflow infusion combined with micro-embolization induced 83% complete remissions in a study including 100 patients with locally recurrent breast cancer. Stepwise increased local exposure demonstrated concentration-dependent response. Stopflow infusion of the celiac axis combined with microspheres for advanced Stage III and IV pancreatic cancer induced a 96% remission rate (n = 24 patients) at a median survival of 10 months. This was confirmed in a series of consecutive studies including 242 patients. Quality of life was significantly improved in all responding patients. Overall pain response was 80%. A prospective randomized trial in this patient group, comparing systemic vs. regional chemotherapy in the form of intra-arterial infusion with tumor adjusted concentrations, was stopped in an early phase because median survival time was significantly prolonged (P = 0.001) in the arterial group.
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Affiliation(s)
- K R Aigner
- Asklepios Paulinen Klinik, Abteilung für Chirurgische Onkologie, Wiesbaden, Germany
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Reed RA, Teitelbaum GP, Daniels JR, Pentecost MJ, Katz MD. Prevalence of infection following hepatic chemoembolization with cross-linked collagen with administration of prophylactic antibiotics. J Vasc Interv Radiol 1994; 5:367-71. [PMID: 8186609 DOI: 10.1016/s1051-0443(94)71504-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The authors present their experience with 494 hepatic chemoembolization (HCE) procedures in 236 patients with administration of a mixture of cross-linked collagen and chemotherapeutic agents. The prevalence of infectious complications was compared in patients who did and did not receive prophylactic administration of antibiotics as part of the HCE procedure. PATIENTS AND METHODS Fourteen HCE procedures in nine patients were performed without prophylactic antibiotics (PA). These patients underwent embolization with cross-linked collagen alone or with low-dose cisplatinum. All of the remaining 480 procedures in 227 patients were performed with PA. RESULTS One of the nine patients (11%) who did not receive PA experienced fatal sepsis within 24 hours of HCE. Of the 227 patients who did receive antibiotics, six (2.6%) developed hepatic abscess and no fatal sepsis was encountered. CONCLUSION Use of PA decreases the prevalence of infectious complications following HCE.
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Affiliation(s)
- R A Reed
- Department of Radiology, University of Southern California School of Medicine, Los Angeles
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Sato M, Yamada R, Uchida B, Hedgepeth P, Rosch J. Effects of hepatic artery embolization with Lipiodol and gelatin sponge particles on normal swine liver. Cardiovasc Intervent Radiol 1993; 16:348-54. [PMID: 8131165 DOI: 10.1007/bf02603139] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to evaluate the effects of hepatic artery embolization (HAE) with Lipiodol (Lp) and gelatin sponge particles (GSP) on swine liver tissue, we embolized the hepatic arteries of 3 pigs with GSP, 9 with Lp, and 9 with Lp + GSP. None of the pigs embolized with GSP died spontaneously during the 4-week experimental period. One pig embolized with 1 ml/kg Lp and three pigs with 2 ml/kg Lp died within 2 h. Two pigs embolized with 0.5 ml/kg Lp + GSP died the following day. The portal vein pressure (PVP) and wedge hepatic vein pressure (WHVP) values before HAE, immediately after, 1 h after, and 4 weeks after HAE showed no remarkable change in the GSP group. Remarkable and temporary elevation was observed in the more than 0.2 ml/kg Lp group. Remarkable and continuous elevation was observed in the 0.2 ml/kg Lp + GSP and 0.5 ml/kg Lp + GSP groups. Gross and histological studies demonstrated no liver damage in the GSP and Lp group. Liver infarction, circular coagulation necrosis with pseudocapsule, and liver atrophy were found in the Lp + GSP group 4 weeks after HAE. The incidence of infarction, circular coagulation necrosis, and liver atrophy in the livers embolized with 0.2 ml/kg Lp + GSP and 0.5 ml/kg Lp + GSP were 67%, 100%, and 75%, respectively. In conclusion, when the hepatic artery is embolized with Lp + GSP, the volume of Lp should be limited to less than 0.1 ml/kg.
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Affiliation(s)
- M Sato
- Department of Radiology, Wakayama Medical College, Japan
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Pentecost MJ, Daniels JR, Teitelbaum GP, Stanley P. Hepatic chemoembolization: safety with portal vein thrombosis. J Vasc Interv Radiol 1993; 4:347-51. [PMID: 8513208 DOI: 10.1016/s1051-0443(93)71873-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Nine patients with unresectable hepatic malignancy and portal vein thrombosis underwent hepatic chemoembolization. PATIENTS AND METHODS Six patients had primary malignancies (hepatocellular carcinoma in five, hepatoblastoma in one), and three had metastatic tumor (adenocarcinoma of the colon in two, glucagonoma in one). Chemoembolization was performed with 10 mg/mL of cross-linked collagen, 10 mg/mL of mitomycin, 3 mg/mL of doxorubicin, and 3 mg/mL of cisplatin. Each patient was treated until flow in the hepatic artery ceased completely. RESULTS All treatments were technically successful. Eight patients responded to treatment, including two long-term survivors (> 2 years). One patient died 31 days after treatment of progressive hepatic malignancy and atherosclerotic disease. No patient developed hepatic infarction or insufficiency as a result of treatment. Follow-up ranged from 1 to 26 months (mean, 13 months). CONCLUSION Portal vein thrombosis should not be considered an absolute contraindication to hepatic chemoembolization. Hepatic chemoembolization can be performed safely in the presence of adequate collateral circulation.
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Affiliation(s)
- M J Pentecost
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104
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Borner M, Castiglione M, Triller J, Baer HU, Soucek M, Blumgart L, Brunner K. Considerable side effects of chemoembolization for colorectal carcinoma metastatic to the liver. Ann Oncol 1992; 3:113-5. [PMID: 1606081 DOI: 10.1093/oxfordjournals.annonc.a058123] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The feasibility of one whole liver chemoembolization (CE) procedure with Angiostat, a vasoocclusive collagen, mitomycin, doxorubicin, and cisplatin was evaluated in eight patients with unresectable colorectal carcinoma metastatic to the liver and good performance status. One heavily pretreated patient showed a partial response in the liver lasting 188 days. Five patients had stabilization of the disease for 85-150 days. The side effects of the treatment were considerable with a fatigue syndrome lasting up to eight weeks, chemical and ischemic hepatitis, severe thrombopenia (WHO grade 4 in 2 pts) and icterus being the most disturbing toxicities. We recommend to restrict CE to patients with a life expectancy of more than 4-6 months confined to protocols, which evaluate efficacy, toxicity and influence on quality of life of CE with various cytotoxic drugs. We further suggest to perform staged unilobar CE at 4- to 6-week intervals rather than whole liver CE.
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Affiliation(s)
- M Borner
- Institute of Medical Oncology, University of Bern, Inselspital Bern, Switzerland
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Graeb DA, Morris DC, Ricci DR, Tyers GF. Balloon embolization of latrogenic aortocoronary arteriovenous fistula. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 20:58-62. [PMID: 2344611 DOI: 10.1002/ccd.1810200115] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A detachable latex balloon was used to occlude an iatrogenic aortocoronary arterio-venous fistula. The aim of providing retrograde myocardial perfusion was not achieved to any significant degree because of rapid recruitment of collateral venous routes to the coronary sinus. This may have implications for the effectiveness of deliberate grafting of the coronary venous system with proximal venous ligation, as has been recommended when the coronary arterial system is small and diffusely diseased.
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Affiliation(s)
- D A Graeb
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Kar R, Opfell RW, Wile AG. The pharmacology of hepatic regional administration of cisplatin in a rabbit model. CANCER DRUG DELIVERY 1987; 4:225-32. [PMID: 3454249 DOI: 10.1089/cdd.1987.4.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pharmacology of hepatic regional administration of CisplatinR (DDP) was examined in a rabbit model. Routes and modes of administration were: IV, hepatic arterial infusion (HAI), HAI with stopflow, HAI with microembolic material [collagen for embolization (CFE)], and portal vein (PV). DDP was rapidly administered, blood samples were drawn over 45 minutes, and hepatic tissue was obtained. Filterable plasma DDP levels were measured by HPLC. Hepatic DDP levels were determined by atomic absorption spectroscopy. All modes of regional administration yielded significantly higher hepatic DDP levels when compared to tissue levels following IV administration. Only the PV and HACFE routes resulted in significantly less systemic drug exposure (AUC) when compared to IV administration. These data indicate a relative pharmacologic advantage of 1.8 for HAI, 3.4 for PV, 1.8 for HAI stopflow, and 4.3 for HACFE compared to IV DDP administration. This pre-clinical study demonstrates substantial pharmacologic advantage for PV and HACFE routes of DDP administration and suggests that clinical trials based on this information be considered.
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Affiliation(s)
- R Kar
- Department of Surgery, University of California, Irvine
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