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Yu Q, Ahmed O. Hepatic Arterial Infusion Chemotherapy for Unresectable HCC: Ready for Primetime? Acad Radiol 2024; 31:844-845. [PMID: 38365493 DOI: 10.1016/j.acra.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Qian Yu
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago, Chicago, Illinois, USA
| | - Osman Ahmed
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago, Chicago, Illinois, USA.
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2
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Zhang C, Thiels CA. Hepatic Artery Infusion Pump Chemotherapy for Colorectal Liver Metastases: What Does the Colorectal Surgeon Need to Know? Dis Colon Rectum 2024; 67:200-204. [PMID: 37994462 DOI: 10.1097/dcr.0000000000003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota
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Zhao M, Guo Z, Zou YH, Li X, Yan ZP, Chen MS, Fan WJ, Li HL, Yang JJ, Chen XM, Xu LF, Zhang YW, Zhu KS, Sun JH, Li JP, Jin Y, Yu HP, Duan F, Xiong B, Yin GW, Lin HL, Ma YL, Wang HM, Gu SZ, Si TG, Wang XD, Zhao C, Yu WC, Guo JH, Zhai J, Huang YH, Wang WY, Lin HF, Gu YK, Chen JZ, Wang JP, Zhang YM, Yi JZ, Lyu N. Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations. Hepatol Int 2024; 18:4-31. [PMID: 37864725 DOI: 10.1007/s12072-023-10599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/17/2023] [Indexed: 10/23/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.
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Affiliation(s)
- Ming Zhao
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Ying-Hua Zou
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Shan Chen
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wei-Jun Fan
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Liang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Ji-Jin Yang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Ming Chen
- Department of Interventional Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yue-Wei Zhang
- Hepatopancreatbiliary Center, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Kang-Shun Zhu
- Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-Hui Sun
- Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Interventional Treatment Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Ping Li
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yong Jin
- The Interventional Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Peng Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Feng Duan
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Bin Xiong
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Wen Yin
- Department of Interventional Radiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Lan Lin
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yi-Long Ma
- Department of Interventional Therapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hua-Ming Wang
- Department of Interventional Therapy, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shan-Zhi Gu
- Department of Interventional Therapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Tong-Guo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Xiao-Dong Wang
- Departments of Interventional Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chang Zhao
- Department of Interventional Therapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Wen-Chang Yu
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jian-Hai Guo
- Departments of Interventional Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jian Zhai
- Department of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Yong-Hui Huang
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Yu Wang
- Department of Interventional Oncology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hai-Feng Lin
- Department of Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yang-Kui Gu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jin-Zhang Chen
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Peng Wang
- Department of Oncology, First People's Hospital of Foshan, Foshan Hospital of Sun Yat-Sen University, Foshan, China
| | - Yi-Min Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Jun-Zhe Yi
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Ning Lyu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
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4
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Khavanin Zadeh M, Chehrehgosha H. Femoral site for implantation of a port-a-catheter in a cancer patient. Eur J Surg Oncol 2024; 50:107971. [PMID: 38272780 DOI: 10.1016/j.ejso.2024.107971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Morteza Khavanin Zadeh
- Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Islamic Republic of Iran.
| | - Haleh Chehrehgosha
- Endocrinology Department, Hazrat Rasool Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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5
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McDonald HG, Zaki OA, Wright MJ, Jayswal R, Weiss H, Nair RT, Ganesh H, Ellis S, Kolesar JM, Moss J, Barry-Hundeyin M, Pandalai PK, Kim J, Patel RA, Cavnar MJ. Phase I Safety and Feasibility Pilot of Hepatic Artery Infusion Chemotherapy in a Rural Catchment Area Using The Codman Vascular Catheter with The Medtronic SynchroMed II Pump for Intrahepatic Cancers. Ann Surg Oncol 2024; 31:1252-1263. [PMID: 38006531 DOI: 10.1245/s10434-023-14519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Discontinuation of the Codman 3000 pump in 2018 left no Food and Drug Administration (FDA)-approved hepatic artery infusion (HAI) device for unresectable colorectal liver metastases (uCLM) and intrahepatic cholangiocarcinoma (uIHC). Historically, HAI has been performed at academic medical centers in large metropolitan areas, which are often inaccessible to rural patients. Consequently, feasibility of dissemination of HAI to rural populations is unknown. PATIENTS AND METHODS Under an FDA investigational device exemption, we opened the only HAI program in Kentucky and enrolled patients with uCLM and uIHC in a phase I clinical trial. The trial examined the safety of the hybrid Codman catheter/Medtronic SynchroMed II pump (hCMP) combination, defined as successful completion of one cycle of HAI chemotherapy. Rural feasibility was assessed by number of missed pump fills appointments. RESULTS A total of 21 patients (n = 17 uCLM, n = 4 uIHC) underwent hCMP implantation before accrual was stopped early owing to FDA approval of the Intera 3000 pump. 20/21 (95%) patients met the primary safety endpoint. Serious adverse events (AEs) included a grade 5 coronavirus disease 2019 (COVID-19) infection (n = 1) and a grade 3 catheter erosion into the bowel (n = 1). Biliary sclerosis developed in two patients (9.5%). Median distance to infusion center was 47.6 miles (2-138 miles), and 62% were from Appalachia, yet there were no missed pump fill appointments. The 2-year overall survival was 82.4% (uCLM) and 50% (uIHC). CONCLUSIONS The hCMP device had an acceptable safety profile. Despite the complexity of starting a new HAI program, early results showed feasibility for HAI delivery in a rural catchment area and comparable outcomes to larger urban-based HAI centers.
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Affiliation(s)
- Hannah G McDonald
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Omar A Zaki
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Matt J Wright
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Rani Jayswal
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Heidi Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rashmi T Nair
- College of Medicine Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Halemane Ganesh
- College of Medicine Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Scott Ellis
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jill M Kolesar
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jessica Moss
- College of Medicine Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Mautin Barry-Hundeyin
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Prakash K Pandalai
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph Kim
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Reema A Patel
- College of Medicine Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael J Cavnar
- College of Medicine Department of Surgery, University of Kentucky, Lexington, KY, USA.
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6
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Bertoglio S. Reply to: Femoral site for implantation of a port-a-catheter in a cancer patient. Eur J Surg Oncol 2024; 50:107970. [PMID: 38262883 DOI: 10.1016/j.ejso.2024.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
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7
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Rao D, Ellis CS, Kemeny N, Cercek A. Case-Based Clinical Guidance on Dosing and Management of the Hepatic Artery Infusion Chemotherapy Pump. JCO Oncol Pract 2024; 20:187-194. [PMID: 37883732 DOI: 10.1200/op.23.00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 10/28/2023] Open
Abstract
Hepatic artery infusion (HAI) delivers localized high-dose floxuridine directly to liver tumors through an implanted pump. While patients are undergoing active treatment, the pump is refilled with chemotherapy alternating with saline every 2 weeks using a specialized noncoring needle. Numerous clinical scenarios influence the dosing of floxuridine, which do not conform to the usual dose modification schema for systemic chemotherapy. This article aims to provide practical clinical management solutions to overcome the common challenges faced by oncologists in the real-world management of HAI pump therapy.
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Affiliation(s)
- Devika Rao
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nancy Kemeny
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Clinical Oncology Pharmacy, College of Pharmacy, University of Kentucky, Lexington, KY
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8
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Janczewski LM, Ellis RJ, Lidsky ME, D'Angelica MI, Merkow RP. Hepatic Artery Infusion Chemotherapy: A Quality Framework. Ann Surg Oncol 2024; 31:701-704. [PMID: 37962738 DOI: 10.1245/s10434-023-14515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, University, Chicago, IL, USA
| | - Ryan J Ellis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael E Lidsky
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan P Merkow
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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9
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Chantada GL, Ceciliano A. Intra-arterial chemotherapy for retinoblastoma: Centralization of care is essential. Pediatr Blood Cancer 2024; 71:e30768. [PMID: 37950438 DOI: 10.1002/pbc.30768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Guillermo L Chantada
- Hospital Sant Joan de Déu, Barcelona, Spain
- Hospital Universitario Austral, Pilar, Argentina
| | - Alejandro Ceciliano
- Hospital Universitario Austral, Pilar, Argentina
- Hospital Universitario Alemán, Buenos Aires, Argentina
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10
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McDonald HG, Zaki OA, Wright MJ, Jayswal R, Weiss H, Nair RT, Ganesh H, Ellis S, Kolesar JM, Moss J, Barry-Hundeyin M, Pandalai PK, Kim J, Patel RA, Cavnar MJ. ASO Visual Abstract: Phase I Safety and Feasibility Pilot of Hepatic Artery Infusion Chemotherapy in a Rural Catchment Area Using the Codman Vascular Catheter with the Medtronic Synchromed II Pump for Intrahepatic Cancers. Ann Surg Oncol 2024; 31:1292-1293. [PMID: 38006533 DOI: 10.1245/s10434-023-14653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
- Hannah G McDonald
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Omar A Zaki
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Matt J Wright
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Rani Jayswal
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Heidi Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rashmi T Nair
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Halemane Ganesh
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Scott Ellis
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jill M Kolesar
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Jessica Moss
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mautin Barry-Hundeyin
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Prakash K Pandalai
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Joseph Kim
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Reema A Patel
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael J Cavnar
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA.
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Tsilimigras DI, Pawlik TM. Adjuvant hepatic arterial infusion chemotherapy in patients with resected hepatocellular carcinoma with microvascular invasion. Chin Clin Oncol 2024; 13:16. [PMID: 37953245 DOI: 10.21037/cco-23-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
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12
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Cao YZ, Zheng GL, Zhang TQ, Shao HY, Pan JY, Huang ZL, Zuo MX. Hepatic arterial infusion chemotherapy with anti-angiogenesis agents and immune checkpoint inhibitors for unresectable hepatocellular carcinoma and meta-analysis. World J Gastroenterol 2024; 30:318-331. [PMID: 38313229 PMCID: PMC10835538 DOI: 10.3748/wjg.v30.i4.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) has been proven to be an ideal choice for treating unresectable hepatocellular carcinoma (uHCC). HAIC-based treatment showed great potential for treating uHCC. However, large-scale studies on HAIC-based treatments and meta-analyses of first-line treatments for uHCC are lacking. AIM To investigate better first-line treatment options for uHCC and to assess the safety and efficacy of HAIC combined with angiogenesis inhibitors, programmed cell death of protein 1 (PD-1) and its ligand (PD-L1) blockers (triple therapy) under real-world conditions. METHODS Several electronic databases were searched to identify eligible randomized controlled trials for this meta-analysis. Study-level pooled analyses of hazard ratios (HRs) and odds ratios (ORs) were performed. This was a retrospective single-center study involving 442 patients with uHCC who received triple therapy or angiogenesis inhibitors plus PD-1/PD-L1 blockades (AIPB) at Sun Yat-sen University Cancer Center from January 2018 to April 2023. Propensity score matching (PSM) was performed to balance the bias between the groups. The Kaplan-Meier method and cox regression were used to analyse the survival data, and the log-rank test was used to compare the suvival time between the groups. RESULTS A total of 13 randomized controlled trials were included. HAIC alone and in combination with sorafenib were found to be effective treatments (P values for ORs: HAIC, 0.95; for HRs: HAIC + sorafenib, 0.04). After PSM, 176 HCC patients were included in the analysis. The triple therapy group (n = 88) had a longer median overall survival than the AIPB group (n = 88) (31.6 months vs 14.6 months, P < 0.001) and a greater incidence of adverse events (94.3% vs 75.4%, P < 0.001). CONCLUSION This meta-analysis suggests that HAIC-based treatments are likely to be the best choice for uHCC. Our findings confirm that triple therapy is more effective for uHCC patients than AIPB.
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Affiliation(s)
- Yu-Zhe Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Guang-Lei Zheng
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Hong-Yan Shao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Jia-Yu Pan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Zi-Lin Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
| | - Meng-Xuan Zuo
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
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Kan P, Srinivasan VM, Gumin J, Garcia R, Chen SR, Johnson JN, Collins DE, Chen MM, Ledbetter D, Huse J, Evan Luna ZA, Robledo A, Vasandani V, Rao A, Singh SK, Shpall EJ, Fueyo J, Gomez-Manzano C, Lang FF. Development of a rabbit human glioblastoma model for testing of endovascular selective intra-arterial infusion (ESIA) of novel stem cell-based therapeutics. Neuro Oncol 2024; 26:127-136. [PMID: 37603323 PMCID: PMC10768973 DOI: 10.1093/neuonc/noad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Endovascular selective intra-arterial (ESIA) infusion of cellular oncotherapeutics is a rapidly evolving strategy for treating glioblastoma. Evaluation of ESIA infusion requires a unique animal model. Our goal was to create a rabbit human GBM model to test IA infusions of cellular therapies and to test its usefulness by employing clinical-grade microcatheters and infusion methods to deliver mesenchymal stem cells loaded with an oncolytic adenovirus, Delta-24-RGD (MSC-D24). METHODS Rabbits were immunosuppressed with mycophenolate mofetil, dexamethasone, and tacrolimus. They underwent stereotactic xenoimplantation of human GBM cell lines (U87, MDA-GSC-17, and MDA-GSC-8-11) into the right frontal lobe. Tumor formation was confirmed on magnetic resonance imaging, histologic, and immunohistochemistry analysis. Selective microcatheter infusion of MSC-D24 was performed via the ipsilateral internal carotid artery to assess model utility and the efficacy and safety of this approach. RESULTS Twenty-five rabbits were implanted (18 with U87, 2 MDA-GSC-17, and 5 MDA-GSC-8-11). Tumors formed in 68% of rabbits (77.8% for U87, 50.0% for MDA-GSC-17, and 40.0% for MDA-GSC-8-11). On MRI, the tumors were hyperintense on T2-weighted image with variable enhancement (evidence of blood brain barrier breakdown). Histologically, tumors showed phenotypic traits of human GBM including varying levels of vascularity. ESIA infusion into the distal internal carotid artery of 2 ml of MSCs-D24 (107 cells) was safe in the model. Examination of post infusion specimens documented that MSCs-D24 homed to the implanted tumor at 24 hours. CONCLUSIONS The intracranial immunosuppressed rabbit human GBM model allows testing of ESIA infusion of novel therapeutics (eg, MSC-D24) in a clinically relevant fashion.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Joy Gumin
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Roberto Garcia
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Stephen R Chen
- Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, The University of California Los Angeles, Los Angeles, California, USA
| | - Dalis E Collins
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Melissa M Chen
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Ledbetter
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jason Huse
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Zean Aaron Evan Luna
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ariadna Robledo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Viren Vasandani
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Abhijit Rao
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sanjay K Singh
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Brañes A, Karanicolas P. Adjuvant Hepatic Artery Infusion Chemotherapy: Still Swimming in Dark Water? Ann Surg Oncol 2024; 31:19-20. [PMID: 37831278 DOI: 10.1245/s10434-023-14445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Alejandro Brañes
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of HPB Surgery, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Paul Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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15
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Kaliki S, Gavara S, Patil G, Palkonda VAR. SECONDARY SALVAGE INTRAVENOUS CHEMOTHERAPY FOR REFRACTORY/RECURRENT RETINOBLASTOMA: A Study of 41 Eyes. Retina 2024; 44:144-150. [PMID: 37656995 DOI: 10.1097/iae.0000000000003923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE To determine the efficacy of secondary salvage intravenous chemotherapy (IVC) for refractory/recurrent retinoblastoma. METHODS Retrospective, nonrandomized interventional case series of 41 eyes of 33 patients with recurrent retinoblastoma. RESULTS Of the 33 patients, mean age at the time of commencement of salvage IVC was 5 years (median, 5 years; range, 2-8 years). At presentation, recurrent retinoblastoma in 41 eyes of 33 patients was classified by the International Classification of Retinoblastoma as Group B (n = 7; 17%), Group C (n = 3; 7%), Group D (n = 16; 39%), and Group E (n = 15; 37%). All patients received 6 cycles of IVC as primary treatment. The indication for secondary salvage IVC with focal treatment included recurrent solid tumor (n = 36; 88%), subretinal seeds (n = 22; 54%), or persistent solid tumor (n = 2; 5%). Mean number of cycles of salvage IVC were 8 (median, 6; range, 6-18). Over a mean follow-up period of 43 months (median, 43 months; range, 12-96 months) after completion of salvage IVC, globe salvage was achieved in 22 (54%) eyes, 1 (3%) patient had histopathology-proven bone metastasis, and 1 (3%) patient died because of presumed metastasis. CONCLUSION Secondary salvage IVC with appropriate focal treatment allows globe salvage in 54% eyes with refractory/recurrent retinoblastoma and thus serves as an alternative to intraarterial chemotherapy or enucleation.
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Affiliation(s)
- Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
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16
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Chintagumpala M, Piao J, Gombos D, Chevez- Barrios P, Brock L, Dunkel IJ, Jubran R, Leahey AM, Kim J, O’Brien J, Shields CL, Rodriguez-Galindo C. A multi-institutional feasibility study of intra-arterial chemotherapy in children with retinoblastoma. A Children's Oncology Group study (COG ARET12P1). Pediatr Blood Cancer 2024; 71:e30718. [PMID: 37817345 PMCID: PMC10842937 DOI: 10.1002/pbc.30718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Intra-arterial chemotherapy (IA) as a treatment to salvage the eye with advanced retinoblastoma is increasingly utilized based on successes reported by institutions around the world mainly through retrospective studies. OBJECTIVE To study the feasibility of delivering melphalan directly into the ophthalmic artery in a multi-institutional prospective study in children with newly diagnosed unilateral group D retinoblastoma. METHODS The Children's Oncology Group (COG) initiated study ARET12P1 in 2014 and was open to nine institutions. Eligible patients older than six months of age were enrolled. The feasibility of delivering three injections of melphalan into the ophthalmic artery every 28 days was assessed. RESULTS Nine institutions participated in this trial. Fourteen patients were enrolled, two of whom were unevaluable for feasibility. Four patients experienced a feasibility failure. In two patients, the ophthalmic artery could not be accessed for the second IA injection, in one the artery could not be accessed for the first injection, and one patient experienced grade 4 hypotension during the procedure. CONCLUSION Delivery of prescribed therapy within the context of this study did not meet the feasibility goals of the study with only a 67% feasibility success rate. These results should caution centers that plan to initiate this treatment and suggest investment in training to achieve technical expertise or referral to centers with expertise.
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Affiliation(s)
- Murali Chintagumpala
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Jin Piao
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dan Gombos
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia Chevez- Barrios
- Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, Texas
| | - Lindsay Brock
- Children's Oncology Group, Monrovia, California, USA
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rima Jubran
- Division of Hematology-Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ann M Leahey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Joan O’Brien
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carol L Shields
- Ocular Oncology Service Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carlos Rodriguez-Galindo
- Departments of Oncology and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
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17
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Lin W, Lu L, Zheng R, Yuan S, Li S, Ling Y, Wei W, Guo R. Vessels encapsulating tumor clusters: a novel efficacy predictor of hepatic arterial infusion chemotherapy in unresectable hepatocellular carcinoma. J Cancer Res Clin Oncol 2023; 149:17231-17239. [PMID: 37801135 DOI: 10.1007/s00432-023-05444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Vessels encapsulating tumor clusters (VETC) is a novel vascular pattern structurally and functionally distinct from microvascular invasion (MVI) in hepatocellular carcinoma (HCC). This study aims to explore the prognostic value of VETC in patients receiving hepatic arterial infusion chemotherapy (HAIC) for unresectable HCC. METHODS From January 2016 to December 2017, 145 patients receiving HAIC as the initial treatment for unresectable HCC were enrolled and stratified into two groups according to their VETC status. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and disease control rate (DCR) were evaluated. RESULTS The patients were divided into two groups: VETC+ (n = 31, 21.8%) and VETC- (n = 114, 78.2%). The patients in the VETC+ group had worse ORR and DCR than those in the VETC- group (RECIST: ORR: 25.8% vs. 47.4%, P = 0.031; DCR: 56.1% vs. 76.3%, P = 0.007; mRECIST: ORR: 41.0% vs. 52.6%, P = 0.008; DCR: 56.1% vs. 76.3%, P = 0.007). Patients with VETC+ had significantly shorter OS and PFS than those with VETC- (median OS: 10.2 vs. 21.6 months, P < 0.001; median PFS: 3.3 vs. 7.2 months, P < 0.001). Multivariate analysis revealed VETC status as an independent prognostic factor for OS (HR: 2.40; 95% CI: 1.46-3.94; P = 0.001) and PFS (HR: 1.97; 95% CI: 1.20-3.22; P = 0.007). CONCLUSION VETC status correlates remarkably well with the tumor response and long-term survival in patients undergoing HAIC. It may be a promising efficacy predictor and help identify patients who will benefit from HAIC.
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Affiliation(s)
- Wenping Lin
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Lianghe Lu
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Rongliang Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
- Department of Nuclear Medicine of Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shasha Yuan
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaohua Li
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China
| | - Yihong Ling
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China.
| | - Wei Wei
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China.
| | - Rongping Guo
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China.
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18
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Han X, Zhao P, Wang X, Tan X, Zhang Y. Application of arterial infusion ports in hepatic arterial infusion chemotherapy and embolization for advanced hepatocellular carcinoma. Saudi Med J 2023; 44:1283-1289. [PMID: 38016739 PMCID: PMC10712783 DOI: 10.15537/smj.2023.44.12.20230147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To investigate the safety and feasibility of subcutaneous implantable infusion ports in repeated hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC) in China. METHODS A total of 237 patients who were clinically diagnosed with advanced HCC (CNLC III a/III b) in our hospitals from December 2020 to October 2022 were retrospectively analyzed. The approaches of HAIC were divided into 2 groups: arterial infusion port implantation (group A) and one-time femoral artery catheterization (group B) based on the physicians' suggestion and the patients' intention. The comfort level (evaluated with the General Comfort Questionnaire), complications and average inpatient expenditure were compared between the 2 groups. RESULTS 116 patients were finally enrolled in the study (group A: 69; group B: 47) and completed HAIC (FOLFOX-4 regimen) according to the dosing schedules (mean: 6±1 cycles). The comfort level of group A was greater than that of group B (p<0.05). The average inpatient expenditure of group A was lower than that of group B (5.4±2.4 vs 10.4±1.9 thousand yuan RMB/cycle, p<0.05). No patients developed port incision infection, hematoma or catheter-related thrombosis in group A, whereas four patients had groin hematomas, one had femoral artery dissection and four had deep vein thrombosis in group B. CONCLUSION Hepatic arterial infusion chemotherapy via arterial infusion ports for advanced HCC decreased complications and medical expenditures and improved patient comfort levels compared with indwelling catheters.
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Affiliation(s)
- Xinqiang Han
- From the Department of Interventional Medicine and Vascular Surgery (Han, Zhang), from the Department of Gastroenterology (Wang), and from the First Clinical Medical College (Tan), Binzhou Medical University Hospital; from the Department of Minimally Invasive (Zhao), Interventional Therapy Center, Qingdao Municipal Hospital, Shandong, China.
| | - Peng Zhao
- From the Department of Interventional Medicine and Vascular Surgery (Han, Zhang), from the Department of Gastroenterology (Wang), and from the First Clinical Medical College (Tan), Binzhou Medical University Hospital; from the Department of Minimally Invasive (Zhao), Interventional Therapy Center, Qingdao Municipal Hospital, Shandong, China.
| | - Xuemin Wang
- From the Department of Interventional Medicine and Vascular Surgery (Han, Zhang), from the Department of Gastroenterology (Wang), and from the First Clinical Medical College (Tan), Binzhou Medical University Hospital; from the Department of Minimally Invasive (Zhao), Interventional Therapy Center, Qingdao Municipal Hospital, Shandong, China.
| | - Xiaoyu Tan
- From the Department of Interventional Medicine and Vascular Surgery (Han, Zhang), from the Department of Gastroenterology (Wang), and from the First Clinical Medical College (Tan), Binzhou Medical University Hospital; from the Department of Minimally Invasive (Zhao), Interventional Therapy Center, Qingdao Municipal Hospital, Shandong, China.
| | - Yongzhen Zhang
- From the Department of Interventional Medicine and Vascular Surgery (Han, Zhang), from the Department of Gastroenterology (Wang), and from the First Clinical Medical College (Tan), Binzhou Medical University Hospital; from the Department of Minimally Invasive (Zhao), Interventional Therapy Center, Qingdao Municipal Hospital, Shandong, China.
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19
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Judge SJ, Ghalambor T, Cavnar MJ, Lidsky ME, Merkow RP, Cho M, Dominguez-Rosado I, Karanicolas PJ, Mayo SC, Rocha FG, Fields RC, Patel RA, Kennecke HF, Koerkamp BG, Yopp AC, Petrowsky H, Mahalingam D, Kemeny N, D'Angelica M, Gholami S. ASO Visual Abstract: Current Practices in Hepatic Artery Infusion (HAI) Chemotherapy-An International Survey of the HAI Consortium Research Network. Ann Surg Oncol 2023; 30:8021-8022. [PMID: 37770725 DOI: 10.1245/s10434-023-14281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Sean J Judge
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tara Ghalambor
- Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Michael E Lidsky
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ryan P Merkow
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - May Cho
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Ismael Dominguez-Rosado
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Paul J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Skye C Mayo
- Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Ryan C Fields
- Division of Surgical Oncology, Department of Surgery, Alvin J. Siteman Comprehensive Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Reema A Patel
- Department of Medical Oncology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hagen F Kennecke
- GI Oncology, Providence Health Cancer Institute, Portland, OR, USA
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Adam C Yopp
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | | | - Nancy Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sepideh Gholami
- Department of Surgery, Northwell Health Cancer Institute, New Hyde Park, NY, USA.
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Standring O, Gholami S. First-line Hepatic Artery Infusion for Unresectable CLM Works, but Will We Ever Get There? Ann Surg Oncol 2023; 30:7918-7920. [PMID: 37775685 DOI: 10.1245/s10434-023-14305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
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21
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Verheij FS, Kuhlmann KFD, Silliman DR, Soares KC, Kingham TP, Balachandran VP, Drebin JA, Wei AC, Jarnagin WR, Cercek A, Kok NFM, Kemeny NE, D'Angelica MI. ASO Visual Abstract: Combined Hepatic Artery Infusion Pump and Systemic Chemotherapy in the Modern Era for Chemotherapy-Naive Patients with Unresectable Colorectal Liver Metastases. Ann Surg Oncol 2023; 30:8014-8015. [PMID: 37644245 DOI: 10.1245/s10434-023-14223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Floris S Verheij
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Danielle R Silliman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Niels F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Sakai H, Goto Y, Shimose S, Niizeki T, Kawaguchi T, Akiba J, Yano H, Akagi Y, Fujita F, Hisaka T. [Minimally Invasive Conversion Hepatectomy for Advanced Hepatocellular Carcinoma]. Gan To Kagaku Ryoho 2023; 50:1572-1574. [PMID: 38303345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Some cases of advanced hepatocellular carcinoma(HCC)diagnosed as unresectable(UR)have been reported to undergo conversion surgery following systemic therapy. Furthermore, the combination of atezolizumab plus bevacizumab(Atez/Bev) shows potential therapeutic effects in conversion surgery for UR-HCC. At our hospital, neoadjuvant chemotherapy(NAC) using New-FP therapy(hepatic arterial infusion chemotherapy: HAIC)has been performed for borderline resectable HCC. New-FP therapy for advanced HCC with macrovascular invasion has a high response rate of 70%. For hepatectomy after NAC, a high response rate is required as a pretreatment, and New-FP therapy may be useful as the initial treatment. Limited reports exist of the laparoscopic approach in conversion surgery for advanced HCC. However, 14 cases of minimally invasive liver resection, including 10 cases after New-FP therapy and 4 cases after Atez/Bev therapy, have been safely performed conversion surgery for advanced HCC. In selected patients with advanced HCC, minimally invasive liver resection may be safely performed if the tumor shows shrinkage with various treatments.
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Verheij FS, Kuhlmann KFD, Silliman DR, Soares KC, Kingham TP, Balachandran VP, Drebin JA, Wei AC, Jarnagin WR, Cercek A, Kok NFM, Kemeny NE, D'Angelica MI. Combined Hepatic Arterial Infusion Pump and Systemic Chemotherapy in the Modern Era for Chemotherapy-Naive Patients with Unresectable Colorectal Liver Metastases. Ann Surg Oncol 2023; 30:7950-7959. [PMID: 37639032 DOI: 10.1245/s10434-023-14073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Chemotherapy-naive patients with unresectable colorectal liver metastases (CRLM) have been the best responders to hepatic arterial infusion (HAI) therapy. The current treatment paradigm has drifted away from HAI in the first-line setting. We aimed to analyze outcomes of combined first-line systemic therapy with HAI therapy (HAI+SYS) in the modern era. METHODS We conducted a retrospective study of consecutive chemotherapy-naive patients with unresectable CRLM who received HAI+SYS between 2003 and 2019. Patients were selected from a prospectively maintained database. Outcomes included radiological response rate, conversion to resection (CTR) rate, and overall survival (OS). RESULTS Fifty-eight chemotherapy-naive patients were identified out of 546 patients with unresectable CRLM managed with HAI. After induction treatment, 4 patients (7%) had a complete radiological response, including two durable responses. In total, 32 patients (55%) underwent CTR. CTR or complete response without resection was achieved after seven cycles of systemic therapy and four cycles of HAI therapy. Median OS for the whole cohort was 53.0 months (95% confidence interval 23.0-82.9). Three- and 5-year OS in patients who achieved CTR or complete response versus patients who did not was 88% and 72% versus 27% and 0% respectively. Of patients who underwent CTR, complete and major pathological response (no and <10% viable tumor cells, respectively) was observed in 7 (22%) and 12 patients (38%). CONCLUSIONS Combined HAI+SYS in chemotherapy-naive patients resulted in durable and substantial response in a large proportion of patients. Nearly two-thirds of patients achieved a complete response or proceeded to conversion surgery, which was associated with prolonged survival.
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Affiliation(s)
- Floris S Verheij
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Danielle R Silliman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Niels F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Xu Z, An C, Shi F, Ren H, Li Y, Chen S, Dou J, Wang Y, Yan S, Lu J, Chen H. Automatic prediction of hepatic arterial infusion chemotherapy response in advanced hepatocellular carcinoma with deep learning radiomic nomogram. Eur Radiol 2023; 33:9038-9051. [PMID: 37498380 DOI: 10.1007/s00330-023-09953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Hepatic arterial infusion chemotherapy (HAIC) using the FOLFOX regimen (oxaliplatin plus fluorouracil and leucovorin) is a promising option for advanced hepatocellular carcinoma (Ad-HCC). As identifying patients with Ad-HCC who would obtain objective response (OR) to HAIC preoperatively remains a challenge, we aimed to develop an automatic and non-invasive model for predicting HAIC response. METHODS A total of 458 patients with Ad-HCC who underwent HAIC were retrospectively included from three hospitals (310 for training, 77 for internal validation, and 71 for external validation). The deep learning and radiomic features were extracted from the automatically segmented liver region on contrast-enhanced computed tomography images. Then, a deep learning radiomic nomogram (DLRN) was constructed by integrating deep learning scores, radiomic scores, and significant clinical variables with multivariate logistic regression. Model performance was assessed by AUC and Kaplan-Meier estimator. RESULTS After automatic segmentation, only a few modifications were needed (less than 30 min for 458 patients). The DLRN achieved an AUC of 0.988 in the training cohort, 0.915 in the internal validation cohort, and 0.896 in the external validation cohort, respectively, outperforming other models in HAIC response prediction. Moreover, survival risk stratification was also successfully performed by the DLRN. The overall survival (OS) of the predictive OR group was significantly longer than that of the predictive non-OR group (median OS: 26.0 vs. 12.3 months, p < 0.001). CONCLUSIONS The DLRN provided a satisfactory performance for predicting HAIC response, which is essential to identify Ad-HCC patients for HAIC and may potentially benefit personalized pre-treatment decision-making. CLINICAL RELEVANCE STATEMENT This study presents an accurate and automatic method for predicting response to hepatic arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma, and therefore help in defining the best candidates for this treatment. KEY POINTS • Deep learning radiomic nomogram (DLRN) based on automatic segmentation of CECT can accurately predict hepatic arterial infusion chemotherapy (HAIC) response of advanced HCC patients. • The proposed prediction model can perform survival risk stratification and is an easy-to-use tool for personalized pre-treatment decision-making for advanced HCC patients.
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Affiliation(s)
- Ziming Xu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, 100084, China
| | - Chao An
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Feng Shi
- Department of Minimal Invasive Intervention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - He Ren
- Department of Ultrasound, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuze Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, 100084, China
| | - Song Chen
- Department of Minimal Invasive Intervention, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiaqi Dou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, 100084, China
| | - Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, 100084, China
| | - Shaozhen Yan
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, No. 30 Shuangqing Road, Haidian District, Beijing, 100084, China.
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He X, Li K, Wei R, Zuo M, Yao W, Zheng Z, He X, Fu Y, Li C, An C, Liu W. A multitask deep learning radiomics model for predicting the macrotrabecular-massive subtype and prognosis of hepatocellular carcinoma after hepatic arterial infusion chemotherapy. Radiol Med 2023; 128:1508-1520. [PMID: 37801197 PMCID: PMC10700409 DOI: 10.1007/s11547-023-01719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The macrotrabecular-massive (MTM) is a special subtype of hepatocellular carcinoma (HCC), which has commonly a dismal prognosis. This study aimed to develop a multitask deep learning radiomics (MDLR) model for predicting MTM and HCC patients' prognosis after hepatic arterial infusion chemotherapy (HAIC). METHODS From June 2018 to March 2020, 158 eligible patients with HCC who underwent surgery were retrospectively enrolled in MTM related cohorts, and 752 HCC patients who underwent HAIC were included in HAIC related cohorts during the same period. DLR features were extracted from dual-phase (arterial phase and venous phase) contrast-enhanced computed tomography (CECT) of the entire liver region. Then, an MDLR model was used for the simultaneous prediction of the MTM subtype and patient prognosis after HAIC. The MDLR model for prognostic risk stratification incorporated DLR signatures, clinical variables and MTM subtype. FINDINGS The predictive performance of the DLR model for the MTM subtype was 0.968 in the training cohort [TC], 0.912 in the internal test cohort [ITC] and 0.773 in the external test cohort [ETC], respectively. Multivariable analysis identified portal vein tumor thrombus (PVTT) (p = 0.012), HAIC response (p < 0.001), HAIC sessions (p < 0.001) and MTM subtype (p < 0.001) as indicators of poor prognosis. After incorporating DLR signatures, the MDLR model yielded the best performance among all models (AUC, 0.855 in the TC, 0.805 in the ITC and 0.792 in the ETC). With these variables, the MDLR model provided two risk strata for overall survival (OS) in the TC: low risk (5-year OS, 44.9%) and high risk (5-year OS, 4.9%). INTERPRETATION A tool based on MDLR was developed to consider that the MTM is an important prognosis factor for HCC patients. MDLR showed outstanding performance for the prognostic risk stratification of HCC patients who underwent HAIC and may help physicians with therapeutic decision making and surveillance strategy selection in clinical practice.
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Affiliation(s)
- Xuelei He
- School of Information Sciences and Technology, Northwest University, Xi'an, 710127, Shaanxi Province, People's Republic of China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Ran Wei
- Department of Interventional Radiology and Vascular Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Mengxuan Zuo
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Wang Yao
- Department of Interventional Radiology and Vascular Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People's Republic of China
| | - Zechen Zheng
- Department of Interventional Therapy, Guangdong Provincial Hospital of Chinese, Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, No. 111 Dade Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Xiaowei He
- Department of Interventional Therapy, Guangdong Provincial Hospital of Chinese, Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, No. 111 Dade Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yan Fu
- Department of Interventional Therapy, National Cancer Center/National Clinical, Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical, Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510060, People's Republic of China.
| | - Chao An
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651, Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
| | - Wendao Liu
- Department of Interventional Therapy, Guangdong Provincial Hospital of Chinese, Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, No. 111 Dade Road, Guangzhou, 510080, Guangdong, People's Republic of China.
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Malka D, Verret B, Faron M, Guimbaud R, Caramella C, Edeline J, Galais MP, Bengrine-Lefevre L, Smith D, Dupont-Bierre E, De Baere T, Goéré D, Dartigues P, Lacroix L, Boige V, Gelli M, Pignon JP, Ducreux M. Hepatic arterial oxaliplatin plus intravenous 5-fluorouracil and cetuximab for first-line treatment of colorectal liver metastases: A multicenter phase II trial. Eur J Cancer 2023; 195:113400. [PMID: 37922632 DOI: 10.1016/j.ejca.2023.113400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The efficacy and tolerability of hepatic arterial infusion (HAI) oxaliplatin plus systemic 5-fluorouracil and cetuximab as frontline treatment in patients with colorectal liver metastases (CRLM) are unknown. METHODS In this multicenter, single-arm phase II study, patients with CRLM not amenable to curative-intent resection or requiring complex/major liver resection, and no prior chemotherapy for metastatic disease, received HAI oxaliplatin and intravenous 5-fluorouracil, leucovorin and cetuximab, every two weeks until disease progression, limiting toxicity or at least 3 months after complete response or curative-intent resection/ablation. The primary endpoint was overall response rate (ORR). RESULTS 35 patients, mostly with bilateral (89%), multiple CRLM (>4, 86%; >10, 46%) were enrolled in eight centers. The ORR was 88% (95% CI, 71%-96%) among evaluable patients (n = 32), and 95% (95% CI 70-100%) among the 22 wild-type RAS/BRAF evaluable patients. After a median follow-up of 8.8 years (95% CI, 8.7-not reached), median progression-free survival was 17.9 months (95% CI, 15-23) and median overall survival (OS) was 46.3 months (95% CI, 40.0-not reached). 23 of the 35 patients (66%), including 22 (79%) of the 25 patients with wild-type RAS tumor, underwent curative-intent surgical resection and/or ablation of CRLM. HAI catheter remained patent in 86% of patients, allowing for a median of eight oxaliplatin infusions (range, 1-19). Treatment toxicity was manageable, without toxic death. CONCLUSION HAI oxaliplatin plus systemic 5-fluorouracil and cetuximab appears highly effective in the frontline treatment of patients with unresectable CRLM and should be investigated further.
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Affiliation(s)
- David Malka
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France.
| | - Benjamin Verret
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Matthieu Faron
- Service de Biostatistique et Epidémiologie, Gustave Roussy, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France; Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Caroline Caramella
- Département d'Imagerie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Denis Smith
- Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | | | - Thierry De Baere
- Département d'Imagerie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Diane Goéré
- Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Peggy Dartigues
- Département de Pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ludovic Lacroix
- Département de Biologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Valérie Boige
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Maximiliano Gelli
- Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et Epidémiologie, Gustave Roussy, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Michel Ducreux
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Centre Hospitalier Universitaire Paul Brousse, Villejuif, France
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Elijah J, Schepers AJ, Krauss JC, McDevitt RL. Evaluation of biliary toxicity in patients with hepatic artery infusion pumps. J Oncol Pharm Pract 2023; 29:1915-1920. [PMID: 36823961 DOI: 10.1177/10781552231158744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE Identify risk factors for biliary toxicity in patients with colorectal liver metastases who received floxuridine (FUDR) via a surgically implanted hepatic artery infusion pump (HAIP). Describe the incidence of biliary toxicity and evaluate relevant patterns in the biliary toxicity cohort. METHODS A single center, retrospective, case-control study included adult colorectal cancer patients with liver metastases who received at least one cycle of FUDR via a surgically implanted HAIP from 1 January 2017, to 1 October 2021. Patients were excluded if they had incomplete records, cholangiocarcinoma diagnosis, or received concurrent mitomycin and FUDR. Biliary toxicity criteria derived from existing HAIP literature were utilized to determine whether patients experienced biliary toxicity. Multiple variables were compared by univariate statistical analysis between the biliary toxicity and non-biliary toxicity cohorts to identify potential risk factors for development of FUDR-induced biliary toxicity. RESULTS Out of 50 patients who had a HAIP implanted, 39 met the inclusion criteria. Five of the 39 patients (12.7%) included in the analysis met the pre-specified biliary toxicity criteria. No risk factors for biliary toxicity were identified. All five patients who developed biliary toxicity demonstrated elevations in alkaline phosphatase (ALP) prior to meeting the toxicity criteria. CONCLUSION Biliary toxicity remains a significant and therapy-limiting consequence of FUDR administration. Rising ALP may be an early indicator of subsequent biliary toxicity. Future studies with more patients may identify risk factors that can facilitate risk mitigation strategies.
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Affiliation(s)
- Joseph Elijah
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Allison J Schepers
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - John C Krauss
- Department of Hematology/Oncology, Michigan Medicine, Ann Arbor, MI, USA
| | - Rachel L McDevitt
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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Pan Y, Yuan Z, Wang J, Ngai S, Hu Z, Sun L, Yang Z, Hu D, Chen M, Zhou Z, Zhang Y. Survival benefit and impact of adjuvant therapies following FOLFOX-HAIC-based conversion therapy with unresectable hepatocellular carcinoma: a retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:14761-14774. [PMID: 37589925 DOI: 10.1007/s00432-023-05243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Recently, the conversion therapies of FOLFOX-HAIC for patients with unresectable hepatocellular carcinoma (uHCC) have dramatically increased the tumor responses and conversion rate; thus, the prognosis of uHCC patients was expected to be prolonged. However, the postoperative recurrence of uHCC patients who successfully underwent conversion therapies stayed high. The present study evaluated the efficacy and safety of postoperatively adjuvant therapy in treating uHCC patients who received FOLFOX-HAIC-based conversion therapy. METHODS In this real-world retrospective study, uHCC patients who received FOLFOX-HAIC-based conversion therapy were included. The recurrence-free survival (RFS), as primary outcomes, was compared between patients who received adjuvant therapy (AT group) or non-adjuvant therapy (nAT group) using survival analysis and Cox regression. Imbalances in baseline clinical features between the two groups were adjusted through propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). RESULTS Between January 2016 and December 2022, 204 uHCC patients who received FOLFOX-HAIC-based conversion therapy were included and assigned into AT group (n = 47) and nAT group (n = 157), respectively. The median RFS was significantly longer in the AT group than the nAT group before adjustment [19.2 vs. 10.8 months; hazard ratio (HR), 0.584; 95% CI, 0.383-0.892; P = 0.028], after PSM and after IPTW. Subsequent subgroup analyses revealed the RFS of adjuvant therapy was best in uHCC patients with younger than 60 years, macrovascular invasion, and positive hepatitis B surface antigen. CONCLUSION Postoperatively, adjuvant therapy was associated with improved survival outcomes compared with non-adjuvant therapy after FOLFOX-HAIC-based conversion therapy among uHCC patients, especially for patients with macrovascular invasion and positive hepatitis B surface antigen.
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Affiliation(s)
- Yangxun Pan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Ze Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Jiongliang Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Siegmund Ngai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Zhiwen Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Liyang Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Zhenyun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Dandan Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Minshan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Zhongguo Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
| | - Yaojun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
- Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
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Deng M, Cai H, He B, Guan R, Lee C, Guo R. Hepatic arterial infusion chemotherapy versus transarterial chemoembolization, potential conversion therapies for single huge hepatocellular carcinoma: a retrospective comparison study. Int J Surg 2023; 109:3303-3311. [PMID: 37578432 PMCID: PMC10651280 DOI: 10.1097/js9.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/23/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The treatment efficacy of transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for huge single hepatocellular carcinoma (HCC) has not been fully documented. The aim of this study was to compare TACE and HAIC for patients with solitary nodular HCCs greater than or equal to 10 cm without vascular invasion and metastasis. METHODS From July 2015 to June 2020, a total of 147 patients with single nodular HCC greater than or equal to 10 cm without vascular invasion and metastasis receiving TACE ( n =77) or HAIC ( n =70) were retrospectively enrolled. The tumor response, overall survival (OS), and progression-free survival (PFS) were investigated and compared. The treatment outcome of two transarterial interventional therapies was explored. RESULTS The objective response rate and PFS were higher in patients who received HAIC than in those who received TACE (44.3 vs. 10.4% and 8.9 vs. 4.2 months, respectively; P =0.001 and P =0.030), whereas the disease control rate and OS were not significantly different (92.9 vs. 84.4% and 21.3 vs. 26.6 months, respectively; P =0.798 and P =0.749). The decreased levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients treated with HAIC were significantly higher than those treated with TACE ( P =0.038 and P <0.001). Multivariable analysis showed that the aspartate aminotransferase/platelet ratio index was associated with OS, whereas albumin-bilirubin grade and PIVKA-II were associated with PFS. CONCLUSIONS HAIC has better potential than TACE to control local tumors for huge single HCC without vascular invasion and metastasis and thus may be the preferred conversion therapy for these tumors.
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Affiliation(s)
- Min Deng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen
| | - Hao Cai
- Department of Transplantation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Benyi He
- Department of Liver Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Renguo Guan
- Department of Liver Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
| | - Carol Lee
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China
| | - Rongping Guo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou
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Fuga M, Tanaka T, Teshigawara A, Murayama Y. Local thrombolytics via balloon-assisted intra-arterial infusion as rescue therapy for thromboembolism during endovascular coil embolisation. BMJ Case Rep 2023; 16:e256134. [PMID: 37879706 PMCID: PMC10603458 DOI: 10.1136/bcr-2023-256134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
Thromboembolism is the most frequent complication of coil embolisation for intracranial aneurysm. Complications of thromboembolism can lead to stroke and have a serious impact on sequelae and mortality, necessitating appropriate rescue therapy. Here, we succeeded in recanalisation of an occluded stent by balloon-assisted local infusion of a thrombolytic agent following stent-assisted coil embolisation of an unruptured posterior communicating artery aneurysm. This method involves inflating a microballoon just distal to the occluded vessel and then administering a thrombolytic agent through a microcatheter. This technique may increase the rate of vessel reopening by maximising the local drug concentration. This method can be applied to any type of thrombolytic agent and helps reduce the dose of systemic drugs, which might decrease the incidence of haemorrhagic complications. Balloon-assisted intra-arterial thrombolytic infusion for an occluded vessel during endovascular coil embolisation could offer an alternative rescue therapy when conventional thrombolytic agent administration fails to improve thromboembolism.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa‑shi, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa‑shi, Chiba, Japan
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa‑shi, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Kano S, Suzuki T, Yoshida D, Tsushima N, Hamada S, Yasuda K, Uchinami Y, Aoyama H, Homma A. The superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT) is effective for metastatic lymph nodes in head and neck squamous cell carcinoma. Int J Clin Oncol 2023; 28:1121-1128. [PMID: 37289379 DOI: 10.1007/s10147-023-02363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT) is a very promising treatment modality for locally advanced head and neck squamous cell carcinoma. However, there are some concerns regarding its potential for the control of neck lymph node metastasis. The objective of this study was to investigate whether RADPLAT provided inferior regional control compared to intravenous chemoradiotherapy (IV-CRT). METHODS A total of 172 patients with neck lymph node metastases, 66 of whom underwent RADPLAT and 106 IV-CRT, were enrolled in this study. We retrospectively compared regional control rates between RADPLAT and IV-CRT. Furthermore, to adjust for differences in factors related to patient background between the groups, we conducted inverse probability weighting (IPW) analysis using the propensity score. RESULTS A comparison between the two groups revealed that the regional control rates were almost equal under unadjusted conditions; however, after adjustment by IPW analysis, the RADPLAT group had a relatively better regional control rate than did the IV-CRT group (1 year regional control rate: 86.6% vs. 79.4%). In addition, the analysis of relative risk factors for regional control in the RADPLAT group showed that the absence of intra-arterial cisplatin infusion into metastatic lymph nodes was the only independent risk factor (Hazard ratio: 4.23, p = 0.04). CONCLUSION This study showed that the regional control rate in patients treated with RADPLAT was noninferior to that for IV-CRT. Locally advanced head and neck cancers is a good indication for RADPLAT, even if the patients have neck lymph node metastases.
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Affiliation(s)
- Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Daisuke Yoshida
- Diagnostic Imaging Center, Sapporo Yamanoue Hospital, Sapporo, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Seijiro Hamada
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Chang E, Zhou Y, Musch D, Edmonds A, Sedig L, Hutchinson R, Chaudhary N, Demirci H. Comparing internal versus external carotid artery branch delivery of intraarterial chemotherapy for the treatment of retinoblastoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:2679-2687. [PMID: 37010593 DOI: 10.1007/s00417-023-06037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/27/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE The goal of this study was to compare the efficacy of intraarterial chemotherapy (IAC) for retinoblastoma delivered via the ophthalmic artery (OA) division of the internal carotid artery (ICA) versus alternative branches of the external carotid artery (ECA). METHODS We performed a retrospective chart review of patients receiving IAC for retinoblastoma at a single institution. Subjects were divided into three groups: those that received IAC solely through the OA branch of the ICA, those that initially received IAC through the OA branch of the ICA but were later switched to the ECA, and those that only received IAC through the ECA. The main outcomes compared included globe salvage rate and reduction in tumor thickness and size. RESULTS A total of 30 eyes from 26 patients were included. A total of 91 (58%) sessions of IAC were performed through the OA division of the ICA and 65 (42%) were performed through branches of the ECA. Eleven eyes (37%) solely received IAC through the OA branch of the ICA, 16 eyes (53%) were converted to ECA treatment, and 3 eyes solely received IAC through branches of the ECA. Statistical analysis did not show any significant difference in globe salvage rate or reduction in tumor thickness and size. CONCLUSION The use of alternative approaches for IAC when the OA branch of the ICA catheterization is not feasible allows for safe continued delivery of highly effective IAC, leading to similar outcomes in terms of globe salvage and reduction in tumor size.
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Affiliation(s)
- Emily Chang
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI, USA
| | - David Musch
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Amy Edmonds
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, USA
| | - Laura Sedig
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, USA
| | - Raymond Hutchinson
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, USA
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI, USA.
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Liang KW, Wang B, Huang HH, Tsao TF, Tyan YS, Wang PH. Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain. J Vasc Interv Radiol 2023; 34:1485-1492.e1. [PMID: 37295555 DOI: 10.1016/j.jvir.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Kim SH, Chun HJ, Kim Y, Oh JS, Choi BG, Lee HG. Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach. Acta Radiol 2023; 64:2667-2672. [PMID: 37337646 DOI: 10.1177/02841851231181321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. PURPOSE To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). MATERIAL AND METHODS A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. RESULTS The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). CONCLUSION For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.
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Affiliation(s)
- Su Ho Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Youdong Kim
- Vascular Center, MINT Intervention Hospital, Songpa-gu, Seoul, Republic of Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, Republic of Korea
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Hill AL, Cullinan DR, Ahmed O, Vachharajani N, Scherer MD, Olumba F, Khan AS, Chapman WC, Doyle MB. ASO Visual Abstract: Liver Transplant After Hepatic Artery Infusion Pump Therapy: Single-Center Experience and Technical Considerations. Ann Surg Oncol 2023; 30:4781-4782. [PMID: 37286707 DOI: 10.1245/s10434-023-13683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Angela L Hill
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA.
| | - Darren R Cullinan
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Ola Ahmed
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Neeta Vachharajani
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Meranda D Scherer
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Franklin Olumba
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Adeel S Khan
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Majella B Doyle
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
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He J, Cameron AM. Is Hepatic Artery Infusion Pump Therapy a New Bridging Strategy to Liver Transplant for Advanced Liver Malignancy? Ann Surg Oncol 2023; 30:4569-4570. [PMID: 37266805 DOI: 10.1245/s10434-023-13674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Jin He
- The Department of Surgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew M Cameron
- The Department of Surgery, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Verma R, Adewara BA, Reddy Palkonda VA, Reddy S, Kaliki S. Salvage Intra-arterial Chemotherapy for Recurrent or Persistent Intraocular Retinoblastoma: A Study of 24 Eyes. Ophthalmol Retina 2023; 7:275-281. [PMID: 36195261 DOI: 10.1016/j.oret.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze the outcomes of salvage intra-arterial chemotherapy (IAC) for recurrent or persistent intraocular retinoblastoma after failure with other treatment modalities. DESIGN Retrospective study. SUBJECTS Twenty-four eyes of 23 patients. INTERVENTION Intra-arterial chemotherapy. MAIN OUTCOME MEASURES Globe salvage, metastasis, and death. RESULTS The mean age at the time of salvage IAC was 41 months (median, 36 months; range, 14-86 months). All patients (n = 23) received IV chemotherapy (IVC) as the primary treatment. The mean number of IVC cycles before salvage IAC was 10 (median, 12; range, 6-18). The indications for salvage IAC were tumor recurrence (n = 17; 71%) or persistent tumor (n = 7; 29%) post-IVC. The mean number of salvage IAC cycles was 3 (median, 3; range, 1-6). Of 24 eyes, 17 eyes (71%) achieved tumor regression with salvage IAC, whereas 7 (29%) eyes displayed poor response. Of these 17 eyes with initial tumor regression, 9 (38%) eyes sustained good response, whereas 8 (33%) eyes displayed tumor recurrence over a mean follow-up period of 21 months (median, 21 months; range, 6-44 months). The mean interval between IAC and tumor recurrence (n = 8) was 4 months (median, 3 months; range, 1-14 months). Of these 8 eyes, globe salvage was achieved in 5 (21%) eyes with additional alternate treatment. Of the 7 eyes with poor response to IAC, globe salvage was achieved in 1 (4%) eye with additional alternate treatment. Overall, globe salvage was achieved in 15 (63%) eyes. CONCLUSIONS Salvage IAC is an effective treatment for recurrent and persistent retinoblastoma, enabling globe salvage in 63% cases. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ritesh Verma
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Bolajoko Abidemi Adewara
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Vijay Anand Reddy Palkonda
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India; Apollo Cancer Hospital, Hyderabad, India
| | | | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India.
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Soliman M. Potential Value of Liver Enhancing Tumor Burden at CT to Predict Survival after Intra-arterial Treatment for Neuroendocrine Liver Metastases. Radiol Imaging Cancer 2023; 5:e239008. [PMID: 37000003 PMCID: PMC10077082 DOI: 10.1148/rycan.239008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Ouyang H, Ma W, Si T, Liu D, Chen P, Gerdtsson AS, Song J, Ni Y, Luo J, Yan Z. Systemic Chemotherapy With or Without Hepatic Arterial Infusion Chemotherapy for Liver Metastases From Pancreatic Cancer: A Propensity Score Matching Analysis. Clin Colorectal Cancer 2023; 22:111-119. [PMID: 36473779 DOI: 10.1016/j.clcc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The significance of systemic chemotherapy (SCT) combined with hepatic arterial infusion (HAI) chemotherapy in the treatment of pancreatic ductal adenocarcinoma with liver metastases (PACLM) remains unclear. Based on previous studies, this single-center propensity score matching (PSM) study aimed to explore the efficacy of SCT with or without HAI for PACLM. PATIENT AND METHODS The PSM method was used to screen 661 cases of PACLM who received SCT at Tianjin Medical University Cancer Institute and Hospital from 2001 to 2020. According to the 1:6 ratio with PSM, 385 patients were divided into the SCT+HAI group (n = 55) and the SCT group (n = 330). After a median follow-up of 49 (range 7-153) months, overall survival (OS) and survival-related prognostic factors were analyzed. RESULTS The main baseline characteristics of the SCT+HAI group and the SCT alone group were matched appropriately (P > .05). After PSM, the median OS for patients in the 2 groups was 10.6 and 7.6 months, respectively (P = .02). Multivariate analysis revealed that peritoneal metastases (P = .03), CA199 ≥ 500U/mL (P = .03), and lactate dehydrogenase (LDH) ≥ 250U/L (P = .03) were prognostic factors of poor survival, modern SCT plus HAI (P = .04) was a protective factor. CONCLUSION Our findings indicated that adequate cycles of SCT+HAI result in better survival than SCT alone in patients with PACLM. Patients with peritoneal metastases, markedly elevated CA19-9 and LDH have a poorer prognosis. The conclusion has yet to be validated in randomized controlled clinical trials.
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Affiliation(s)
- Huaqiang Ouyang
- Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Weidong Ma
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Pancreatic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tongguo Si
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Interventional Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Donglin Liu
- Department of Mathematics, Lund University, Lund, Sweden
| | - Ping Chen
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Anna Sandström Gerdtsson
- Department of Immunotechnology, CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Jiahong Song
- Department of Cardiology, The second hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yue Ni
- The Nursing Department, Beijing Bo Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Juanjuan Luo
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Zhuchen Yan
- Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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Marasligiller SA, Williams BK, Vadivelu S, Correa ZM, Abruzzo TA, Nicola MD, Lane A, Geller JI. Ocular survival after intra-arterial chemotherapy for retinoblastoma improves with accrual of experience and programmatic evolution. Pediatr Blood Cancer 2023; 70:e30071. [PMID: 36349521 PMCID: PMC9790034 DOI: 10.1002/pbc.30071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/14/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy (IAC) for the treatment of intraocular retinoblastoma has gained recognition as a method to improve ocular salvage; however, there is a paucity of evidence supporting treatment factors prognosticating ocular survival. METHODS All patients with retinoblastoma treated with IAC at a single institution between December 2008 and December 2019 were evaluated. Patient demographics, tumor classification, prior treatments, procedural data, other non-IAC therapies, adverse reactions, procedural complications, ocular outcomes, and overall survival were assessed via retrospective chart review. Factors suggestive of increased ocular survival were identified via univariate and multivariate analyses. The impact of accrued treatment experience was evaluated by grouping eyes by the respective year, IAC treatment was initiated. RESULTS Forty-nine eyes of 43 patients were treated for retinoblastoma with IAC (256 total procedures). At least grade 3 neutropenia was observed following 19% of IAC procedures. The risk of neutropenia was not statistically different between single or multidrug IAC. Comparing those who received balloon-assisted intra-arterial chemotherapy (bIAC) in more than two-thirds of cycles to those who did not, the risk of arterial access site complications was not statistically different. Multivariate analysis revealed a significantly lower risk of enucleation associated with treatment era in years (hazard ratio [HR] = 0.52-1.00, p < .05) and laser therapies (HR = 0.02-0.60, p < .05). CONCLUSIONS Ocular survival rates in patients treated with IAC for retinoblastoma at our institution have increased over time. Accrued treatment experience and programmatic changes have likely contributed. Larger, prospective series may lead to a better understanding of factors that consistently contribute to better ocular salvage.
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Affiliation(s)
- Stefan A Marasligiller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Basil K Williams
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sudhakar Vadivelu
- Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zelia M Correa
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
- Ocular Oncology Program, Retina Service, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Todd A Abruzzo
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Maura Di Nicola
- Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Rigault E, Lacas B, Glehen O, Smith D, Dupont-Bierre E, Guimbaud R, Malka D, Boige V, Fuerea A, Pignon JP, Ducreux M. Intra-arterial hepatic bevacizumab and systemic chemotherapy in hepatic metastasis of colorectal cancer: A phase II multicentric trial in second-line treatment. Cancer Treat Res Commun 2023; 34:100674. [PMID: 36565566 DOI: 10.1016/j.ctarc.2022.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Intra-arterial hepatic (IAH) treatment has shown promising results in the management of patients with unresectable colorectal liver metastases (CRLM) the prognosis of which is poor. Bevacizumab adjunction to standard chemotherapy has been shown to improve survival of this patient population. This prospective study was conducted to assess the efficacy and safety of IAH bevacizumab combined to systemic chemotherapy after first-line treatment failure in patients with CRLM. METHODS Included patients had dominant or isolated unresectable CRLM progressing after standard first-line treatment for metastases of colorectal cancer. Three patients had less than 30% liver invasion, three patients between 30 and 50%, two more than 50% and data was missing in two patients. An intra-hepatic catheter was implanted surgically or percutaneously. Bevacizumab 7.5 mg/kg was administered once every 3 weeks in combination with capecitabine 2000 mg/m² per day for 2 weeks and oxaliplatin 130 mg/m² or irinotecan 200 mg/m² once every 3 weeks. The primary end-point was the objective response rate. RESULTS Between June 2013 and February 2015, 10 patients were included. The trial was prematurely closed because of the lack of financial support and poor accrual. The patients had a median of 6 [1-9] cycles of treatment. Partial response was achieved in 2 patients (20%) and a R0 liver metastases resection in one another. All patients died of disease progression. The median overall and progression-free survival rates were respectively 14.0 (95% IC [4.8 - 25.8] and 5.4 months (95% IC [1.6 - 6.2]). Four patients had severe side effects but no toxic death occurred. CONCLUSION IAH bevacizumab combined to systemic chemotherapy is feasible and safe in patients with unresectable isolated or dominant CRLM progressing after a first-line systemic treatment. Based on the low number of patients included in our study, our results suggest that this treatment does not increase dramatically the response rate versus an adapted systemic treatment. However, considering the safety data provided in this study, arterial infusion of bevacizumab in adjunction to chemotherapeutic agents could be evaluated in the future.
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Affiliation(s)
- Eugénie Rigault
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Benjamin Lacas
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Center, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Olivier Glehen
- Département de Chirurgie Digestive, Hospices Civils de Lyon, Université Lyon Rhône, France
| | - Denis Smith
- Département d'Hépato-Gastro-Enterologie et d'oncologie digestive, Hôpital Haut-Lévêque, Bordeaux, France
| | | | - Rosine Guimbaud
- Département d'oncologie médicale, Université de Toulouse, Toulouse, France
| | - David Malka
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France; Unité Dynamique des Cellules Tumorales - Inserm U1279, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Valérie Boige
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Alina Fuerea
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Center, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France; Unité Dynamique des Cellules Tumorales - Inserm U1279, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Université Paris-Saclay, Saint Aubin, France.
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Marathe PH, Dunkel IJ, Francis JH, Antal Z, Gobin YP, Abramson DH, Friedman DN. Biochemical measures of ovarian function in female survivors of retinoblastoma treated with intra-arterial melphalan: an initial report. Ophthalmic Genet 2022; 43:806-808. [PMID: 36695494 PMCID: PMC10364467 DOI: 10.1080/13816810.2022.2132516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 01/26/2023]
Abstract
Since 2006, ophthalmic artery chemosurgery (OAC) has been used for ocular-sparing treatment of retinoblastoma. Systemic exposure to melphalan is known to cause ovarian dysfunction, but the effect of melphalan-based OAC has not yet been determined. Here, we assess biochemical and symptomatic measures of ovarian function in a cohort of pubertal female survivors of retinoblastoma treated with melphalan-based OAC. These 13 patients all had normal gonadotropins at a median age of 11.1 years, 9.6 years from the completion of therapy. None had symptoms of ovarian dysfunction. This study provides initial evidence that ovarian function remains intact after melphalan-based OAC.
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Affiliation(s)
- Priya H Marathe
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zoltan Antal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Y Pierre Gobin
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
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Li J, Jing C, Hua X, Liang T, Li J, Zhao P, Ji X. Outcome of salvage intra-arterial chemotherapy for recurrent retinoblastoma. Eye (Lond) 2022; 36:2106-2110. [PMID: 34654891 PMCID: PMC9581931 DOI: 10.1038/s41433-021-01693-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 06/14/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the outcome of salvage intra-arterial chemotherapy (IAC) for patients with recurrent retinoblastoma after the initial course of IAC and determine the factors influencing clinical outcome. METHODS A total of 73 eyes of 71 patients with recurrent retinoblastoma undergoing salvage IAC after initial successfully IAC between May 2014 and May 2019 were retrospectively reviewed for clinical outcomes. Ocular survival and progression-free survival were used to examine the efficacy of salvage IAC. The factors influencing clinical outcomes were determined using univariate and multivariate analyses. RESULTS The salvage IAC was delivered at mean 9.4 months (median 7, range 2.1-38.3 months) following the last cycle of initial IAC. 86.5% (64/73) eyes relapsed 16 months after the initial IAC. After the salvage IAC, 57 eyes (78.1%) were salvaged, and no further-line therapies were required for 36 eyes (49.3%). The 2-year Kaplan-Meier ocular survival and progression-free survival estimates after salvage IAC were 66.4% (95% CI, 31.5-42.1%) and 38.2% (95% CI, 17.8-28.8%), respectively. Univariate and multivariate analyses showed that the ocular survival and progression-free survival after salvage IAC were significantly associated with the history of vitreous seeds (p = 0.02 and p = 0.03, respectively). CONCLUSION Salvage IAC is effective for the management of recurrent retinoblastoma after the initial successful IAC. Eyes with a history of vitreous seeds in the course of the disease are more likely to relapse and with worse ocular survival. A close follow-up strategy is imperative to treat the recurrent tumour after salvage IAC.
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Affiliation(s)
- Jiakai Li
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaohui Jing
- Department of Neurosurgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuming Hua
- Department of Neurosurgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingyi Liang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xunda Ji
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Datta J, Narayan RR, Goldman DA, Chatila WK, Gonen M, Strong J, Balachandran VP, Drebin JA, Kingham TP, Jarnagin WR, Schultz N, Kemeny NE, D'Angelica MI. Distinct Genomic Profiles are Associated With Conversion to Resection and Survival in Patients With Initially Unresectable Colorectal Liver Metastases Treated With Systemic and Hepatic Artery Chemotherapy. Ann Surg 2022; 276:e474-e482. [PMID: 33214457 PMCID: PMC8502489 DOI: 10.1097/sla.0000000000004613] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine genomic correlates of conversion to resection (CTR and overall survival (OS) in patients with initially unresectable colorectal liver metastasis (IU-CRLM) treated with combination systemic and hepatic artery infusion (HAI) chemotherapy. BACKGROUND In patients presenting with IU-CRLM, combination systemic and HAI chemotherapy enables CTR with associated long-term OS in a subset of patients. Genomic correlates of CTR and OS in IU-CRLM have not been previously explored. METHODS Specimens from IU-CRLM patients receiving systemic/HAI chemotherapy (2003-2017) were submitted for next-generation sequencing. Fisher Exact test assessed associations with CTR, and Kaplan-Meier/Cox methods assessed associations with OS from HAI initiation. RESULTS Of 128 IU-CRLM patients, 51 (40%) underwent CTR at median 6 months (range: 3-35) from HAI initiation. CTR and persistently unresectable cohorts differed significantly in preoperative systemic chemotherapy exposure, node-positive primary status, and size of largest liver metastasis. Median and 5-year OS was 66 months and 51%. CTR was associated with prolonged survival (time-dependent HR 0.23,95% CI: 0.12-0.46, P < 0.001). The most frequently altered genes were APC (81%), TP53 (77%), and KRAS (37%). Oncogenic mutations in SOX9 and BRAF were associated with CTR. BRAF mutations, any RAS pathway alterations, and co-altered RAS/RAF-TP53 mutations wereassociated with worse survival. Classification and regression tree analysis defined prognostically relevant clusters of genomic risk to reveal co-altered RAS/RAF-TP53 as the highest risk subgroup. Co-altered RAS/RAF-TP53 remained independently associated with worse survival (HR 2.52, 95% CI: 1.37-4.64, P = 0.003) after controlling for CTR, number of liver metastases, and preoperative extrahepatic disease. CONCLUSIONS Distinct genomic profiles are associated with CTR and survival in patients with IU-CRLM treated with HAI/systemic chemotherapy. Presence of SOX9, BRAF , and co-altered RAS/RAF- TP53 mutations are promising biomarkers that, when validated in larger datasets, may impact treatment of IU-CRLM patients.
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Affiliation(s)
- Jashodeep Datta
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Raja R. Narayan
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Debra A. Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Walid K. Chatila
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Tri-Institutional Program in Computational Biology and Medicine, Weill Cornell Medical College, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Strong
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vinod P. Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey A. Drebin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William R. Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy E. Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael I. D'Angelica
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Lai Z, Huang Y, Wen D, Lin X, Kan A, Li Q, Wei W, Chen M, Xu L, He M, Shi M. One day versus two days of hepatic arterial infusion with oxaliplatin and fluorouracil for patients with unresectable hepatocellular carcinoma. BMC Med 2022; 20:415. [PMID: 36310160 PMCID: PMC9620590 DOI: 10.1186/s12916-022-02608-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin and 5-fluorouracil was effective in unresectable hepatocellular carcinoma (HCC). The program of FOLFOX-HAIC in HCC was performed for 1 day (HAIC 1d) or 2 days (HAIC 2d). We hereby retrospectively compared the efficacy and safety between these two treatment regimens and explored the predictive power of thymidylate synthase (TYMS), an enzyme involved in the DNA synthesis process and metabolism of fluorouracil. METHODS This study included patients with a primary diagnosis of unresectable HCC. These patients received HAIC for 1 day or 2 days. The overall survival (OS), progression-free survival (PFS), tumor response, and adverse events were compared. The propensity score matching (PSM) was used to reduce bias. Peripheral blood samples before the treatments were collected and used to measure the concentration of TYMS through enzyme-linked immunosorbent assay (ELISA). ELISA was performed according to the manufacturers' guidelines. RESULTS We included 368 patients for this study: 248 in the HAIC 1d group and 120 in the HAIC 2d group. There was no significant difference of OS between the two groups (14.5 for HAIC 1d vs 15.3 months for HAIC 2d, p=0.46). Compared with the HAIC 1d group, the HAIC 2d group did not prolong the PFS (7.3 vs 7.5 months, p=0.91) or elevate the tumor response (42.5% vs 39.1%, p=0.53) per RECIST 1.1. In the PSM cohort, the efficacy between the two groups was similar. The total frequencies of grade 3-4 events were higher with the HAIC 2d group than with the HAIC 1d group, especially in the PSM cohort (p=0.043). Additionally, patients with TYMS low level might benefit longer OS from the HAIC 2d group (18.7 vs 13.6 months, p=0.014). CONCLUSIONS There was not much of a difference in efficacy between the two groups, but the HAIC for 1 day might be safer, which needed further research. The level of TYMS might be the predictive biomarkers.
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Affiliation(s)
- Zhicheng Lai
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Yexing Huang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Dongsheng Wen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Xuanjia Lin
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Anna Kan
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Qijiong Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Wei Wei
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Minshan Chen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Li Xu
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Minke He
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
| | - Ming Shi
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060 China
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Li L, He J, Xie YX, Huang XH, Weng XT, Pan XT, Jiao YB, Zheng HH, Qiu LB, Guo WH. [A retrospective controlled study of TACE-HAIC-targeted-immune quadruple therapy for intermediate and advanced-stage hepatocellular carcinoma]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:939-946. [PMID: 36299187 DOI: 10.3760/cma.j.cn501113-20220823-00432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC)-targeted-immune quadruple therapy in patients with intermediate and advanced-stage hepatocellular carcinoma (HCC). Methods: 101 patients with intermediate and advanced stage HCC were enrolled according to the inclusion and exclusion criteria, and then they were divided into a combination group and a control group. Patients in the combination group was treated with TACE-HAIC-targeted-immune quadruple therapy, while the control group was only treated with TACE therapy. The overall survival (OS), progression-free survival (PFS), and treatment-related adverse reactions were statistically analyzed in the two groups of patients. Statistical analysis was carried out by t-test, χ2 test, rank sum test, Kaplan-Meier curve, log-rank test, Cox regression (or proportional hazards model) analysis according to different data. Results: The tumor objective response rate and disease control rate as evaluated by mRECIST 1.1 criteria in the combination group were 80% and 94%, respectively, which were significantly higher than those in the control group, 41.2% (P<0.001) and 74.5% (P=0.007). The OS and PFS of the combination group were 15.6 months [95%CI 11.3-NA ] and 8.8 months [95%CI 6.9-12.0], respectively, which were significantly better than the control group at 6.1 months [95%CI 5.3-6.6] (P<0.001) and 3.2 months [95%CI 3.0-3.6] (P<0.001). Gastric ulcer incidence was significantly higher in the combination group (9/50, 18%) than that in the control group (2/51, 3.9%) (P=0.023). Conclusion TACE-HAIC-targeted-immune quadruple therapy is a more effective treatment mode for intermediate and advanced-stage HCC than TACE alone, and attention should be paid to the monitoring of target immune-related adverse reactions.
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Affiliation(s)
- L Li
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China The First Clinical Medical College of Fujian Medical University, Fuzhou 350005, China
| | - J He
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - Y X Xie
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - X H Huang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - X T Weng
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - X T Pan
- United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - Y B Jiao
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - H H Zheng
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - L B Qiu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - W H Guo
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
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Wu DD, He XF, Tian C, Peng P, Chen CL, Liu XH, Pang HJ. Tumor-feeding artery diameter reduction is associated with improved short-term effect of hepatic arterial infusion chemotherapy plus lenvatinib treatment. World J Gastroenterol 2022; 28:3232-3242. [PMID: 36051348 PMCID: PMC9331530 DOI: 10.3748/wjg.v28.i26.3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/17/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently, hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib has been frequently used to treat unresectable hepatocellular carcinoma (uHCC) in China. In the clinic, the hepatic arteries of some patients shrink significantly during this treatment, leading to improved short-term efficacy.
AIM To investigate the relationship between the shrinkage of hepatic arteries and the short-term effect of HAIC plus lenvatinib treatment.
METHODS Sixty-seven participants with uHCC were enrolled in this retrospective study. The patients received HAIC every 3 wk, followed by oral lenvatinib after the first HAIC course. Hepatic artery diameters were measured on CT before treatment and after 1 and 2 mo of treatment. Meanwhile, the changes in tumor capillaries were also examined on pathological specimens before and after 1 mo of treatment. The antitumor response after 1, 3, and 6 mo of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). The relationship between the changes in vessel diameters and the short-term effect of the combination treatment was evaluated by receiver-operating characteristic and logistic regression analyses.
RESULTS The hepatic artery diameters were all significantly decreased after 1 and 2 mo of treatment (P < 0.001), but there was no difference in the vessel diameters between 1 and 2 mo (P > 0.05). The microvessel density in the tumor lesions decreased significantly after 1 mo of combination treatment (P < 0.001). According to mRECIST, 46, 41, and 24 patients had complete or partial responses after 1, 3, and 6 mo of treatment, respectively, whereas 21, 21, and 32 patients had a stable or progressive disease at these times, respectively. Shrinkage of the tumor-feeding artery was significantly associated with the tumor response after 1, 3, and 6 mo of treatment (P < 0.001, P = 0.004, and P = 0.023, respectively); however, changes in other hepatic arteries were not significantly associated with the tumor response. Furthermore, shrinkage of the tumor-feeding artery was an independent factor for treatment efficacy (P = 0.001, P = 0.001, and P = 0.002 and 1, 3, and 6 mo, respectively).
CONCLUSION The hepatic arteries shrank rapidly after treatment with HAIC plus lenvatinib, and shrinkage of the tumor-feeding artery diameter was closely related to improved short-term efficacy.
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Affiliation(s)
- De-Di Wu
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xiao-Feng He
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Chen Tian
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Peng Peng
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Chuan-Li Chen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xue-Han Liu
- Department of Statistics, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Hua-Jin Pang
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Chamorro Á, Torres F. Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke-Reply. JAMA 2022; 327:2456. [PMID: 35763000 DOI: 10.1001/jama.2022.7430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ángel Chamorro
- Department of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ferrán Torres
- Biostatistics Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
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49
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Mai H, Chen T, Chen F. Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke. JAMA 2022; 327:2455-2456. [PMID: 35763003 DOI: 10.1001/jama.2022.7427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hui Mai
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Tao Chen
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, England
| | - Fengjian Chen
- Department of Neurology, Central People's Hospital of Zhanjiang, Zhanjiang, China
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Ruben M, Eiger-Moscovich M, Yaghy A, Tadepalli S, Shields CL. Iodine-125 Plaque Radiotherapy for Retinoblastoma Recurrence Following Intra-arterial Chemotherapy. J Pediatr Ophthalmol Strabismus 2022; 59:164-171. [PMID: 34928770 DOI: 10.3928/01913913-20210903-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the efficacy and toxicity of Iodine-125 (I-125) plaque radiotherapy for retinoblastoma following intra-arterial chemotherapy (IAC). METHODS Clinical records of patients with retinoblastoma who received I-125 plaque radiotherapy after IAC at the Ocular Oncology Service at Wills Eye Hospital between December 1, 2009 and April 30, 2020, were retrospectively reviewed. RESULTS Forty-one retinoblastomas in 41 eyes of 41 patients were treated with I-125 plaque radiotherapy after IAC at a median age of 32 months. The indication for plaque radiotherapy was solid tumor recurrence with or without overlying subretinal/vitreous seeds (n = 33, 80%), subretinal seeds alone (n = 6, 15%), and vitreous seeds alone (n = 2, 5%). The median irradiated basal diameter and thickness was 9 and 4 mm, respectively. Mean radiation dose to tumor apex was 3,483 centigray (cGy) delivered at mean rate of 35 cGy/hr. The irradiated site was controlled in 39 eyes (95%) at a median of 20 months after plaque radiotherapy for solid tumor (31 of 33, 94%), subretinal (6 of 6,100%), and vitreous seeds (2 of 2, 100%). A subgroup of tumors occurring within an ischemic retinal/choroidal field was identified on fluorescein angiography (n = 24) and demonstrated control in 22 of 24 (92%). Using Kaplan-Meier analysis, radiation complications at 2 years included vitreous hemorrhage (37%), retinopathy (28%), papillopathy (18%), and cataract (18%). Five eyes (12%) were enucleated for recurrence outside the irradiated area, chronic vitreous hemorrhage, and/or total retinal detachment. CONCLUSIONS Iodine-125 plaque radiotherapy provided 95% control for retinoblastoma tumors that failed IAC, including those in ischemic fields untreatable with further chemotherapy. Radiation complications should be anticipated in eyes exposed to substantial chemotherapy. [J Pediatr Ophthalmol Strabismus. 2022;59(3):164-171.].
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