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Wang H, Tang X, Xie L, Dong S, Chen C, Guo W. Stop-Flow Pelvic Chemoperfusion for the Treatment of Malignant Pelvic Bone Tumors: A Preliminary Study. Orthop Surg 2020; 12:741-748. [PMID: 32243077 PMCID: PMC7307261 DOI: 10.1111/os.12666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 01/25/2023] Open
Abstract
Objective To preliminarily study the efficacy and safety of stop‐flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies. Methods Stop‐flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop‐flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03. Results The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of −4.7%, −5.4%, +4.7%, −8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%, <60%, and 93%. No severe complications were observed in this study. Conclusions Stop‐flow pelvic chemoperfusion resulted in exposure to drug higher concentration with fewer serious complications. These preliminary results suggest that further studies are required to comprehensively assess the therapeutic potential of stop‐flow pelvic chemoperfusion in pelvic malignancies.
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Affiliation(s)
- Han Wang
- Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China
| | - Lu Xie
- Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China
| | - Sen Dong
- Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China
| | - Chen Chen
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China
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Xie L, Xu J, Dong S, Gao J, Tang X, Yan T, Yang R, Guo W. Gain and loss from transcatheter intra-arterial limb infusion of cisplatin for extremity osteosarcoma: a retrospective study of 99 cases in the past six years. Cancer Manag Res 2019; 11:7183-7195. [PMID: 31447583 PMCID: PMC6684488 DOI: 10.2147/cmar.s214604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/10/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose We intend to analyze the gain and loss from transcatheter intra-arterial (IA) limb infusion of cisplatin for extremity osteosarcoma in the past six years. Patients and methods Between December 2009 and August 2014, a total of 99 patients were analyzed for efficiency and followed up for long-term survival. Based on the different administration methods of cisplatin, we divided them into the following two cohorts: IA infusion of cisplatin (n=48) and intravenous (IV) infusion of cisplatin (n=51). Except for cisplatin, all the other drugs were given intravenously. Cisplatin was given intra-arterially with an infusion time of 3 hrs or 6 hrs using a pump, whereas historical controls received IV infusion of cisplatin within 60 mins. Tumor neovascularity (TNV) was analyzed before infusion, and subsequent arteriograms were compared with the baseline to determine percent changes. Definitive surgery with intended wide resection and postoperative pathological evaluation were performed in all these patients. Results No local or overall survival benefit was found in the patients preoperatively treated with IA infusion of cisplatin compared with IV infusion (P=0.336 and 0.173, respectively). Furthermore, serial arteriography was used to predict a good histologic response with an accuracy of 73.1% and a sensitivity of 100%. There were sporadic cases with the telangiectatic subtype, which did not respond very well to IV chemotherapy, but later, the tumor obviously shrank after IA infusion of cisplatin. Our study also showed that the rates of the complication of skin and muscle necrosis were not so low as reported. Conclusion We did not observe any survival advantage of chemotherapy using IA infusion in osteosarcoma of the extremities. Arteriography for TNV can be used to predict the tumor histologic response. Malposition of the catheter might severely increase the complication of skin or muscle necrosis.
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Affiliation(s)
- Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Sen Dong
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jian Gao
- Catheterization Room & Radiology Department, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
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Aiba H, Yamada S, Mizutani J, Yamamoto N, Okamoto H, Hayashi K, Takeuchi A, Miwa S, Higuchi T, Abe K, Taniguchi Y, Tsuchiya H, Otsuka T. Efficacy of radio-hyperthermo-chemotherapy as salvage therapy for recurrent or residual malignant soft tissue tumors. Int J Hyperthermia 2018; 35:658-666. [PMID: 30295115 DOI: 10.1080/02656736.2018.1518545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Recurrence after wide excision or residual tumor after an unplanned excision of a malignant soft tissue sarcoma (STS) is a complex problem, due to a higher recurrence rate and poorer survival rate compared with primary resection. Regional hyperthermia was used, with the expectation that it will enhance the anti-tumor effects of chemotherapy and radiotherapy. This study aimed to assess the efficacy of neoadjuvant concomitant radiotherapy, hyperthermia, and chemotherapy (RHC) for salvage of recurrent or residual malignant STS. METHODS We identified 64 patients with recurrent or residual STS treated between 1994 and 2013. After excluding those with low-grade malignancy, with recurrent bone tumor in the soft tissues, with truncal STS, and who declined to participate, 23 patients (7 with recurrence and 16 with residual tumor) underwent RHC. The histologic diagnoses were undifferentiated pleomorphic sarcoma (n = 11), synovial sarcoma (n = 3), leiomyosarcoma and myxoid liposarcoma (n = 2 each), and other histologic types. As primary outcomes, the 5-year overall survival (OS), distant metastasis-free survival (D-MFS), and local control (LC) rates were evaluated by Kaplan-Meier analysis. RESULTS The median follow-up period was 112.3 months. The 5-year OS, D-MFS, and LC were 86.4%, 77.4%, and 86.7%, respectively. In the univariate analysis, tumor depth was considered as a negative prognostic factor for OS and D-MFS, and a positive margin was also a negative prognostic factor for OS, D-MFS LC with retained on Cox proportional hazards model in OS, and D-MFS. CONCLUSION RHC is an effective option for salvage treatment of recurrent and residual STS.
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Affiliation(s)
- Hisaki Aiba
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan.,b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Satoshi Yamada
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Jun Mizutani
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Norio Yamamoto
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Hideki Okamoto
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Katsuhiro Hayashi
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Akihiko Takeuchi
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Shinji Miwa
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan.,b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Takashi Higuchi
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Kensaku Abe
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Yuta Taniguchi
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Hiroyuki Tsuchiya
- b Department of Orthopaedic Surgery , Graduate School of Medical Science, Kanazawa University , Kanazawa , Japan
| | - Takanobu Otsuka
- a Department of Orthopaedic Surgery , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
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Kim SH, Shin KH, Moon SH, Kong Y, Suh JS, Yang WI. Location of residual viable tumor cells after neoadjuvant chemotherapy: A new concept with high prognostic performance in osteosarcoma. J Surg Oncol 2017; 115:752-759. [PMID: 28403564 DOI: 10.1002/jso.24571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to establish a new concept for evaluating responses to neoadjuvant chemotherapy in osteosarcoma. METHODS A total of 56 high-grade extremity osteosarcoma patients were retrospectively reviewed. A new conceptual method was derived from locations of residual viable tumor cells (LRVTC) after chemotherapy, whether extracompartmental or intracompartmental, rather than quantitative measurements of necrosis rates of tumor cells. RESULTS LRVTC after chemotherapy was independently associated with overall survival ([OS]hazard ratio [HR] = 6.502, P = 0.008) after adjustment for Huvos grade (HR = 3.694, P = 0.045), alkaline phosphatase ([ALP] HR = 2.140, P = 0.226), size (HR = 0.318, P = 0.133), joint extension (HR = 2.309, P = 0.162), and metastasis at diagnosis (HR = 8.228, P = 0.009). LRVTC was also independently associated with metastasis (HR = 5.096, P = 0.002) after adjustment for Huvos grade (HR = 2.261, P = 0.101), ALP (HR = 2.558, P = 0.053), size (HR = 1.280, P = 0.641), and joint extension (HR = 1.800, P = 0.254). AUC values of LRVTC for OS and metastasis were superior to those of Huvos grade: AUCs for OS (LRVTC: 0.757, Confidence Interval [CI] = 0.618 to 0.865 vs Huvos grade: 0.590, [CI] = 0.445 to 0.725; AUC = 0.167, P = 0.086) and metastasis (LRVTC: 0.769, CI = 0.631 to 0.874 vs Huvos grade: 0.606, [CI] = 0.461 to 0.739; AUC = 0.163, P = 0.046). CONCLUSIONS LRVTC after chemotherapy may be useful as a new method with high performance for evaluating chemo-responses in osteosarcoma.
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Affiliation(s)
- Seung Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Ho Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Youngho Kong
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Robl B, Botter SM, Pellegrini G, Neklyudova O, Fuchs B. Evaluation of intraarterial and intravenous cisplatin chemotherapy in the treatment of metastatic osteosarcoma using an orthotopic xenograft mouse model. J Exp Clin Cancer Res 2016; 35:113. [PMID: 27421768 PMCID: PMC4947253 DOI: 10.1186/s13046-016-0392-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/08/2016] [Indexed: 12/03/2022] Open
Abstract
Background Osteosarcoma is the most common primary malignancy of bone. Its treatment relies on the administration of neoadjuvant and adjuvant chemotherapy combined with surgery. Alternative to common intravenous (i.v.) administration of chemotherapeutic drugs, clinical studies also evaluated the benefit of intraarterial (i.a.) administrations. However, conflicting results were obtained when both routes of administration of cisplatin (CDDP), a gold standard drug in osteosarcoma treatment, were compared. In order to overcome clinical confounding factors, we evaluated both routes of drug administration in a mouse model of experimental osteosarcoma. Methods We directly compared i.v. versus i.a. drug infusions of cisplatin (CDDP), in an orthotopic xenograft mouse model of metastatic osteosarcoma. We performed tumor monitoring using caliper and micro computed tomography and measured tumor perfusion using laser speckle contrast imaging. Histopathological changes were evaluated using hematoxylin and eosin staining as well as immunohistochemistry (cleaved PARP-1, CD31, HIF-1α). Results First, an effective concentration of 4 mg/kg i.a. CDDP was determined that significantly reduced primary tumor volume. We used this concentration of i.a. CDDP and compared it to infusions of i.v. CDDP. Systemic (i.v.) CDDP only showed minor suppression of tumor growth whereas local (i.a.) CDDP strongly inhibited tumor growth and destruction of cortical bone in the tumor-bearing hind limb. Inhibition of tumor growth was linked to a reduced blood perfusion and resulted in increased amounts of tumor necrosis after i.a. CDDP. After treatment with i.a. CDDP, remaining viable tumor tissue responded by increasing expression of HIF-1α. Side effects due to administration of CDDP were minor, showing no differences in kidney damage between i.v. and i.a. CDDP. However, increased epidermal apoptosis in the foot was an indirect marker for locally increased concentrations of CDDP. Conclusions Our findings demonstrate the great potential of local administration of cytotoxic chemotherapeutics, such as CDDP. Consequently, we provide a preclinical basis for a renewed interest in the clinical use of i.a. chemotherapy in osteosarcoma therapy. Electronic supplementary material The online version of this article (doi:10.1186/s13046-016-0392-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bernhard Robl
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Sander Martijn Botter
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Giovanni Pellegrini
- Laboratory for Animal Model Pathology, Veterinary Pathology, Vetsuisse Faculty, Zurich, Switzerland
| | - Olga Neklyudova
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Bruno Fuchs
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland.
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Katagiri H, Sugiyama H, Takahashi M, Murata H, Wasa J, Hosaka S, Miyagi M. Osteosarcoma of the pelvis treated successfully with repetitive intra-arterial chemotherapy and radiation therapy: a report of a case with a 21-year follow-up. J Orthop Sci 2015; 20:568-73. [PMID: 24357190 DOI: 10.1007/s00776-013-0511-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/19/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Hirohisa Katagiri
- Division of Orthopaedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan,
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Intra-arterial chemotherapy with doxorubicin and cisplatin is effective for advanced hepatocellular cell carcinoma. ScientificWorldJournal 2014; 2014:160138. [PMID: 24967421 PMCID: PMC4055608 DOI: 10.1155/2014/160138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022] Open
Abstract
Advanced hepatocellular carcinoma (HCC) remains a fatal disease even in the era of targeted therapies. Intra-arterial chemotherapy (IACT) can provide therapeutic benefits for patients with locally advanced HCC who are not eligible for local therapies or are refractory to targeted therapies. The aim of this retrospective study was to analyze the effect of IACT with cisplatin and doxorubicin on advanced HCC. Methods. Patients with advanced HCC who were not eligible for local therapies or were refractory to sorafenib received doxorubicin (50 mg/m2) and cisplatin (50 mg/m2) infusions into the liver via the transhepatic artery. Between January 2005 and December 2011, a total of 50 patients with advanced HCC received this treatment regimen. The overall response rate (ORR) was 22% in all treated patients. In patients who received at least 2 cycles of IACT, the ORR was 36.7%, and the disease control rate was 70%. Survival rate differed significantly between patients who received only one cycle of IACT (group I) and those who received several cycles (group II). The median progression-free survival was 1.3 months and 5.8 months in groups I and II, respectively (P < 0.0001). The median overall survival was 8.3 months for all patients and was 3.1 months and 12.0 months in groups I and II, respectively (P < 0.0001). The most common toxicity was alopecia. Four patients developed grade 3 or 4 leukopenia. Worsening of liver function, nausea, and vomiting were uncommon side effects. This study demonstrated clinical efficacy and tolerable side effects of repeated IACT with doxorubicin and cisplatin in advanced HCC. Our regimen can be an alternative choice for patients with adequate liver function who do not want to receive continuous infusion of IACT.
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Zhang GB, Li J, Zhang PF, Han LJ, Zhang JT. Radiation-induced malignant fibrous histiocytoma of the occipital: a case report. World J Surg Oncol 2014; 12:98. [PMID: 24742094 PMCID: PMC3999727 DOI: 10.1186/1477-7819-12-98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. Effective treatment modality is surgical resection with wide margins, but its rate of recurrence and metastasis is still high. Early detection and complete excision of the tumor is necessary. A MFH of the occipital developed in a 51-year-old woman eight years after surgery and radiation for medulloblastoma of the cerebellar vermis. The secondary neoplasm arose at the site of tumor resection within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. Radiation-induced sarcoma (RIS) is well known, but radiation-induced MFH is relatively rare in the head and neck region, especially in the occipital. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by computerized tomography (CT) and magnetic resonance imaging (MRI) and appreciation of the expected latency period may help in providing the diagnosis of RIS.
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Affiliation(s)
| | | | | | | | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Chongwen District, Beijing 100050, PR China.
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Tse DT, Kossler AL, Feuer WJ, Benedetto PW. Long-term outcomes of neoadjuvant intra-arterial cytoreductive chemotherapy for lacrimal gland adenoid cystic carcinoma. Ophthalmology 2013; 120:1313-23. [PMID: 23582989 DOI: 10.1016/j.ophtha.2013.01.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the long-term outcomes after intra-arterial cytoreductive chemotherapy (IACC) with conventional treatment for lacrimal gland adenoid cystic carcinoma (ACC). DESIGN Retrospective case series. PARTICIPANTS Nineteen consecutive patients treated with IACC, followed by orbital exenteration, chemoradiotherapy, and intravenous chemotherapy. INTERVENTIONS Analyses of the histologic characteristics of biopsy specimens, extent of disease at the time of diagnosis, diagnostic surgical procedures, incidence of locoregional recurrences or distant metastases, disease-free survival time, response to IACC, tumor margins at definitive surgery, and toxicity and complications. MAIN OUTCOME MEASURES Disease relapse, disease-free survival, and chemotherapeutic complications. RESULTS Eight patients with an intact lacrimal artery had significantly better outcomes for survival (100% vs. 28.6% at 10 years), cause-specific mortality, and recurrences (all P = 0.002, log-rank test) than conventionally treated patients from the University of Miami Miller School of Medicine. These 8 patients (group 1) had cumulative 10-year disease-free survival of 100% compared with 50% for 11 patients (group 2) who had an absence of the lacrimal artery or deviated from the treatment protocol (P = 0.035) and 14.3% for conventionally treated patients (P<0.001). Likewise, group 2 was associated with lower cause-specific mortality than the institutional comparator group (P = 0.038). Prior tumor resection with lateral wall osteotomy, delay in IACC implementation or exenteration, and failure to adhere to protocol are risk factors for suboptimal outcomes. CONCLUSIONS Neoadjuvant IACC seems to improve overall survival and decrease disease recurrence. An intact lacrimal artery, no disruption of bone barrier or tumor manipulation other than incisional biopsy, and protocol compliance are factors responsible for favorable outcomes. The chemotoxicity complication rate is limited and manageable.
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Affiliation(s)
- David T Tse
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
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Comprehensive treatment based on intra-arterial chemotherapy for distal femur neoplasms. Pathol Oncol Res 2013; 19:489-93. [PMID: 23417371 DOI: 10.1007/s12253-013-9606-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Abstract
To investigate the clinical efficacy of intra-arterial chemotherapy by subcutaneous implantable delivery system (SIDS) in the treatment of distal femur neoplasm. From March 2002 to December 2009, 51 patients were treated with SIDS intra-femoral artery chemotherapy, followed by customized prosthetic reconstruction, including 45 patients of osteosarcoma and 6 malignant fibrous histiocytoma in distal femur. The average follow-up period was 64 months (ranging between 24 and 116 months) to track on the efficacy of chemotherapy, which shows that 96.1 % of patients got pain relief, 70.6 % of patients had significant radiological change, and 82.4 % of paitents with medium to severe pathological variation responded to the chemotherapy. Local recurrence happened in 4 cases, 3 cases are alive with disease, 4 cases died because of pulmonary metastases and other 40 patients are free of local recurrence or distant metastasis. SIDS intra-femur artery chemotherapy can improve clinical outcome of DFN, and provide effective method for treatment of DFN when combined with customized prosthetic reconstruction.
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Berndt K, Vogel J, Buehler C, Vogt P, Born W, Fuchs B. A new method for repeated drug infusion into the femoral artery of mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2012; 51:825-831. [PMID: 23294891 PMCID: PMC3508189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 01/09/2012] [Accepted: 04/09/2012] [Indexed: 06/01/2023]
Abstract
Intraarterial chemotherapy (IAC) is considered effective for the treatment of solid tumors with high local doses of systemically toxic chemotherapeutics. Osteosarcoma, which is often located in the extremities, is a potential target for IAC. However, the efficacy of this treatment modality has varied, and standardized protocols are difficult to establish due to tumor heterogeneity and the limited numbers of patients available for clinical trials. Reproducible experimental models are needed to further investigate IAC in osteosarcoma. Here, we describe a new microsurgical technique for repeated infusion of drugs into the mouse femoral artery for local treatment of experimental intratibial metastasizing osteosarcoma. We successfully achieved 5 catheterizations at 3-d intervals in 70% of the mice tested. Laser speckle imaging indicated a maximal 50% reduction in blood flow around the ankle region of catheterized legs infused with 0.5 mg/kg cisplatin. However, blood flow in the front feet was affected only minimally. Histologic examination of catheterized arteries of saline control or cisplatin-treated mice showed circular fibrinoid media necrosis and partial thrombosis, but total occlusion of the arteries was not observed. The method we describe for repeated transient catheterization of the mouse femoral artery likely will be useful in future studies comparing the efficacies of intraarterial and systemic cisplatin treatment of intratibial metastasizing osteosarcoma in mice under standardized conditions.
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Affiliation(s)
- Kersten Berndt
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist University Hospital
| | - Johannes Vogel
- Institute of Veterinary Physiology, Vetsuisse Faculty and Zürich Center for Integrative Human Physiology, and
| | - Christopher Buehler
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist University Hospital
| | - Peter Vogt
- Department of Pathology, Institute for Surgical Pathology, University Hospital of Zurich, Zurich, Switzerland
| | - Walter Born
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist University Hospital
| | - Bruno Fuchs
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist University Hospital
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Guo J, Cui Q, Liu C, Sui J, Jiang N, Zhou J, Li D, Zeng Y. Clinical report on transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma in soft tissue. Clin Transl Oncol 2012; 15:370-5. [PMID: 22975901 DOI: 10.1007/s12094-012-0933-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To review the experience in transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma (MFH) in soft tissue and to analyze the factors related to prognosis of MFH in soft tissue. METHODS Between September 1999 and December 2011, 101 cases of MFH in soft tissue patients treated by transarterial administration of Cisplatin, Adriamycin and Norcantharidin were divided into primary group and recurrent group, and the clinical documents were reviewed. Nine factors that might affect prognosis such as age, sex, tumor size, tumor site, tumor infiltration depth, recurrence if any, pathological type, histologic grade and histologic response of chemotherapy were analyzed statistically. RESULTS The 5-year relapse-free survival rate and the overall survival rate were 70.5 and 75.0 %, respectively, in the primary group; 56.1 and 57.9 %, respectively, in the recurrent group. Univariate analysis (log-rank test) showed that the factors affecting the prognosis were age (P = 0.03), tumor size (P = 0.01), pelvic tumor (P = 0.02), recurrence if any (P = 0.004), histologic grade (P = 0.01), and histologic response to chemotherapy (P = 0.007). Multivariate analysis showed that the major factors affecting prognosis were pelvic tumor (P = 0.01), tumor size (P = 0.002), histologic grade (P = 0.002), recurrence if any (P = 0.0004), and histologic response to chemotherapy (P = 0.008). CONCLUSION Transarterial neoadjuvant chemotherapy can significantly increase the curative efficacy of chemotherapy and survival rate in MFH treatment.
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Affiliation(s)
- Jun Guo
- Department of Orthopedics, 307 Hospital of PLA, No. 8 East Street, Fengtai District, Beijing, 100071, China
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Avritscher R, Javadi S. Transcatheter intra-arterial limb infusion for extremity osteosarcoma: technical considerations and outcomes. Tech Vasc Interv Radiol 2012; 14:124-8. [PMID: 21767779 DOI: 10.1053/j.tvir.2011.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of transcatheter arterial infusion is to achieve better tumor response by delivering chemotherapy directly into the arterial bed supplying a neoplasm. The rationale behind such therapy relies on the potentially increased tumoricidal effect afforded by higher local concentrations of the infused chemotherapic agent(s) combined with longer tissue exposure times. The use of intra-arterial chemotherapy with or without transcatheter embolization before limb salvage surgery has been demonstrated to induce substantial tumor necrosis and reduce intraoperative blood loss. Recent advances in catheter technology have greatly reduced the morbidity associated with the procedure. This article will focus on the technical aspects of intra-arterial chemotherapy for the treatment of extremity osteosarcoma.
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Affiliation(s)
- Rony Avritscher
- Section of Interventional Radiology, Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Li D, Cui Q, Liu Y, Wang X, Liu C, Liu S, Zeng Y. Chemotherapy Response Analysis for Osteosarcom with Intra-arterial Chemotherapy by Subcutaneous Implantable Delivery System. Pathol Oncol Res 2011; 17:947-53. [DOI: 10.1007/s12253-011-9408-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Anninga JK, Gelderblom H, Fiocco M, Kroep JR, Taminiau AHM, Hogendoorn PCW, Egeler RM. Chemotherapeutic adjuvant treatment for osteosarcoma: where do we stand? Eur J Cancer 2011; 47:2431-45. [PMID: 21703851 DOI: 10.1016/j.ejca.2011.05.030] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/11/2011] [Accepted: 05/19/2011] [Indexed: 11/24/2022]
Abstract
AIM Since the introduction of chemotherapy, survival in localised high-grade osteosarcoma has improved considerably. However, there is still no worldwide consensus on a standard chemotherapy approach. In this systematic review evidence for effectiveness of each single drug and the role of response guided salvage treatment of adjuvant chemotherapy are addressed, whereas in a meta-analysis the number of drugs in current protocols is considered. METHODS A systematic literature search for clinical studies in localised high-grade osteosarcoma was undertaken, including both randomised and non-randomised trials. Historical clinical studies from the pre-chemotherapy era were included for comparison purposes. RESULTS Nine historical studies showed a long-term survival of 16% after only local treatment. Fifty single agent phase II studies showed high response rates for adriamycin (A, 43%), ifosfamide (Ifo, 33%), methotrexate (M, 32%), cisplatin (P, 26%) but only 4% for etposide (E). In 19 neo-adjuvant studies the mean 5-year event free survival (EFS) was 48% for 2-drug regimens and 58% for ⩾3 drug regimens, with a 5-year overall survival (OAS) of 62% and 70%, respectively. Meta-analysis showed that ⩾3 drug regimens including methotrexate plus adriamycin plus cisplatin (plus ifosfamide) (MAP(Ifo)) had significant better outcome (EFS: HR=0.701 (95% confidence interval [95% CI]: 0.615-0.799); OAS: HR=0.792 (95% CI: 0.677-0.926) than 2-drug regimens, but there was no significant difference between MAP and MAPIfo (or plus etoposide). Salvage of poor responders by changing drugs, or intensifying treatment postoperatively has not proven to be useful in this analysis. CONCLUSION Meta-analysis in patients with localised high-grade osteosarcoma shows that 3-drug regimens, for example MAP are the most efficacious drug regimens.
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Affiliation(s)
- Jakob K Anninga
- Department of Paediatric Oncology, Leiden University Medical Center, The Netherlands
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Satomi T, Watanabe M, Kaneko T, Matsubayashi J, Nagao T, Chiba H. Radiation-induced malignant fibrous histiocytoma of the maxilla. Odontology 2011; 99:203-8. [DOI: 10.1007/s10266-011-0001-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
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Hong S, Shin SJ, Jung M, Jeong J, Lee YJ, Shin KH, Roh JK, Rha SY. Comparison of Long-Term Outcome between Doublet and Triplet Neoadjuvant Chemotherapy in Non-Metastatic Osteosarcoma of the Extremity. Oncology 2011; 80:107-17. [DOI: 10.1159/000327216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/29/2011] [Indexed: 02/01/2023]
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Kawano M, Nishida H, Nakamoto Y, Tsumura H, Tsuchiya H. Cryoimmunologic antitumor effects enhanced by dendritic cells in osteosarcoma. Clin Orthop Relat Res 2010; 468:1373-83. [PMID: 20232181 PMCID: PMC2853649 DOI: 10.1007/s11999-010-1302-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/01/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously reported a limb-salvage technique by treating tumor-bearing bone with liquid nitrogen. We also reported systemic antitumor immunity was enhanced by cryotreatment in a murine osteosarcoma (LM8) model. We therefore combined the cryotreatment of tumor with dendritic cells to promote tumor-specific immune responses. QUESTIONS/PURPOSES We determined whether our technique could enhance systemic immune response and inhibit metastatic tumor growth in a murine osteosarcoma model. MATERIALS AND METHODS To evaluate activation of the immune response, we prepared six groups of C3H mice (80 mice total): (1) excision only, (2) dendritic cells without reimplantation of the cryotreated primary tumor, (3) reimplantation of the cryotreated primary tumor alone, (4) dendritic cells combined with reimplantation of the cryotreated primary tumor, (5) dendritic cells exposed to cryotreated tumor lysates without reimplantation of the cryotreated primary tumor, and (6) dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor. We then compared and verified the activation state of each group's antitumor immunity. RESULTS Mice that received dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor group had high serum interferon gamma, reduced pulmonary metastases, and increased numbers of CD8(+) T lymphocytes in the metastatic areas. CONCLUSIONS Combining tumor cryotreatment with dendritic cells enhanced systemic immune responses and inhibited metastatic tumor growth. CLINICAL RELEVANCE We suggest immunotherapy could be developed further to improve the treatment of osteosarcoma.
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Affiliation(s)
- Masanori Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yasunari Nakamoto
- Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
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Gastric metastasis of malignant fibrous histiocytoma diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration biopsy: report of a case. Surg Today 2009; 39:1073-5. [PMID: 19997804 DOI: 10.1007/s00595-008-3987-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 12/08/2008] [Indexed: 10/20/2022]
Abstract
Metastatic gastric tumors originating from malignant fibrous histiocytoma (MFH) are rare. We herein report the case of a 75-year-old woman who underwent a distal gastrectomy for gastric metastasis of MFH, who was preoperatively diagnosed by an endoscopic ultrasound-guided fine-needle aspiration biopsy.
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Fuchs B, Hoekzema N, Larson DR, Inwards CY, Sim FH. Osteosarcoma of the pelvis: outcome analysis of surgical treatment. Clin Orthop Relat Res 2009; 467:510-8. [PMID: 18855090 PMCID: PMC2628496 DOI: 10.1007/s11999-008-0495-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Risk factors to explain the poor survival of patients with osteosarcoma of the pelvis are poorly understood. Therefore, we attempted to identify factors affecting survival and development of local recurrence and metastasis. We retrospectively reviewed 43 patients who had high-grade pelvic tumors and were treated surgically. Twenty lesions were chondroblastic, 10 fibroblastic, 11 osteoblastic, and one each was giant cell-rich and small cell osteosarcomas. At a median of 3.5 years (range, 0.3-21 years) postoperatively, 13 patients were alive with no evidence of disease. The overall and disease-free 5-year survival rates were 38% and 29%, respectively, at 5 years. Anatomic location, tumor size, and margin predicted survival. Fifteen patients (35%) had local recurrence. The 5-year cumulative incidence of recurrence with death as a competing risk factor was 34%. Location in the ilium and size of the tumor predicted local recurrence. Twenty-one (49%) of 43 patients had metastases develop. The cumulative incidence of metastasis with death as a competing risk factor was 48% at 5 years. Six patients who presented with metastasis had a worse survival than patients who had no evidence of metastasis at presentation (2-year survival, 33% versus 76%). If distant metastasis is diagnosed subsequent to primary treatment, aggressive therapy may be justified. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bruno Fuchs
- Division of Orthopedic Oncology, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Nathan Hoekzema
- Division of Orthopedic Oncology, Mayo Clinic, Rochester, MN
USA
| | - Dirk R. Larson
- Department of Biostatistics, Mayo Clinic, Rochester, MN USA
| | | | - Franklin H. Sim
- Division of Orthopedic Oncology, Mayo Clinic, Rochester, MN
USA
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