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Riesco-Martinez MC, Modrego A, Espinosa-Olarte P, La Salvia A, Garcia-Carbonero R. Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer: Lessons Learned and Future Perspectives. Curr Treat Options Oncol 2022; 23:1320-1337. [PMID: 35980520 DOI: 10.1007/s11864-022-01008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Colorectal cancer (CRC) is a major public health problem and the 2nd leading-cause of cancer-related death worldwide. Around 30% of patients present with metastatic disease and 50% of those with early disease will eventually relapse. The metastatic spread occurs mainly to the liver, which is the exclusive site in 30-40% of the cases. Surgery is the main curative option for liver recurrence, but only one out of five patients are eligible for resection. Moreover, even if surgery is feasible, recurrence rate is high, occurring in up to 75% of patients. Therefore, additional treatment to improve these disappointing outcomes has been sought. Adjuvant and perioperative chemotherapy aim to eradicate early micrometastatic disease, decreasing recurrence rates, and improving survival outcomes. Different chemotherapy regimens, mainly extrapolated from the adjuvant experience, have showed conflicting results, with improvements in disease free but not in overall survival. The addition of targeted therapies to chemotherapy has improved response rates and resectability when administered preoperatively, but did not have an impact on survival in the adjuvant setting. There is a need to critically synthetize the available evidence on perioperative and conversion therapy from the past years, and appraise areas of current research and potential future directions.
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Affiliation(s)
- Maria C Riesco-Martinez
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Andrea Modrego
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Paula Espinosa-Olarte
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain.
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Laface C, Laforgia M, Molinari P, Foti C, Ambrogio F, Gadaleta CD, Ranieri G. Intra-Arterial Infusion Chemotherapy in Advanced Pancreatic Cancer: A Comprehensive Review. Cancers (Basel) 2022; 14:cancers14020450. [PMID: 35053614 PMCID: PMC8774130 DOI: 10.3390/cancers14020450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Pancreatic cancer has a very poor prognosis. The few available therapeutic options are characterized by low efficacy and high toxicity due to the intrinsic chemoresistance of this tumor type. To improve clinical results, some clinical trials have evaluated regional chemotherapy as a treatment option for PC. The pancreatic arterial infusion of chemotherapeutics has the aim of obtaining higher local concentrations of drugs and, at the same time, of limiting systemic toxicity. This therapeutic approach has already been successfully evaluated for the treatment of several types of tumors. Regarding advanced pancreatic cancers, only a few clinical studies have investigated the safety and efficacy of this treatment, with very promising results. Therefore, in this review, we summarize literature data on the clinical approaches to pancreatic arterial drug administration for the treatment of advanced PC to deepen knowledge on this topic. Abstract Advanced pancreatic cancer (PC) has a very poor prognosis due to its chemoresistant nature. Nowadays, only a few therapeutic options are available for PC, and the most effective ones are characterized by low response rates (RRs), short progression-free survival and overall survival, and severe toxicity. To improve clinical results, small series studies have evaluated loco-regional chemotherapy as a treatment option for PC, demonstrating its dose-dependent sensitivity towards the tumor. In fact, pancreatic arterial infusion (PAI) chemotherapy allows higher local concentrations of chemotherapeutic agents, sparing healthy tissues with a lower rate of adverse events compared to systemic chemotherapy. This therapeutic approach has already been evaluated in different types of tumors, especially in primary and metastatic liver cancers, with favourable results. With regard to advanced PC, a few clinical studies have investigated the safety and efficacy of PAI with promising results, especially in terms of RRs compared to systemic chemotherapy. However, clear evidence about its efficacy has not been established yet nor have the underlying mechanisms leading to its success. In this review, we aim to summarize the literature data on the clinical approaches to pancreatic arterial drug administration in terms of techniques, drug pharmacokinetics, and clinical outcomes for advanced PC.
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Affiliation(s)
- Carmelo Laface
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
- Department of Biomedical Sciences and Clinical Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Mariarita Laforgia
- Pharmacy Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Pasquale Molinari
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari Aldo Moro, 70124 Bari, Italy; (C.F.); (F.A.)
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari Aldo Moro, 70124 Bari, Italy; (C.F.); (F.A.)
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
| | - Girolamo Ranieri
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (C.L.); (P.M.); (C.D.G.)
- Correspondence:
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Zhao J, Zheng Y, Liu T, Chang J, Shan H, Cong K. Comparison between fluoropyrimidine-hepatic arterial infusion and systemic chemotherapy for unresectable liver metastases: A protocol for systematic review and meta-analysis based on 16 observational studies. Medicine (Baltimore) 2021; 100:e27483. [PMID: 34731127 PMCID: PMC8519215 DOI: 10.1097/md.0000000000027483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The benefit of loco-regional treatments such as hepatic arterial infusion (HAI) in terms of survival and response rate is unclear. The aim of this work is to quantitatively summarize the results of both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) comparing fluoropyrimidine-HAI (F-HAI) to systemic chemotherapy (SCT) for the treatment of colorectal liver metastases (CRLMs). METHODS We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to July 1, 2021. The outcome measures were tumor response rate and overall survival (OS). Both RCTs and NRSIs comparing HAI to SCT for patients with unresectable CRLMs were included. The outcome measures were tumor response rate and OS. Two reviewers assessed trial quality and extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2. RESULTS A total of 16 studies including 11 RCTs and 5 NRSIs were identified for the present meta-analysis. Nine RCTs compared F-HAI to SCT for patients with unresectable CRLMs and the pooled result indicated that patients who received F-HAI experienced more than twofold response rate than SCT, with a pooled risk ratio of 2.10 (95%CI 1.59-2.79; P < .00001). In addition, the pooled result based on RCTs showed that F-HAI had a significant benefit regarding OS, with a pooled HR of 0.83 (95% CI 0.70-0.99; P = .04). Similarly, the benefit of F-HAI in terms of OS was also observed in the results of NRSIs. CONCLUSIONS Our results indicated that the F-HAI regimen had a greater tumor response rate and survival advantage than SCT for patients with unresectable CRLMs. Future propensity score-matched analyses with a large sample size should be conducted to support the evidence of our results based on RCTs and NRSIs.
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4
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Zhang Y, Wang K, Yang T, Cao Y, Liang W, Yang X, Xiao T. Meta-Analysis of Hepatic Arterial Infusion for Liver Metastases From Colorectal Cancer. Front Oncol 2021; 11:628558. [PMID: 33777775 PMCID: PMC7989965 DOI: 10.3389/fonc.2021.628558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to evaluate the potential benefits of hepatic arterial infusion chemotherapy (HAIC) in the management of colorectal liver metastases (CRLM). Electronic databases, including PubMed, EMBASE, Medline, Web of Science, and Cochrane Library, were comprehensively searched from inception to November 2020. Prospective randomized trials with HAIC vs. systemic chemotherapy (SC) were selected. The overall survival (OS), tumor response rates (RRs), progression-free survival (PFS), and corresponding 95% confidence intervals (CIs) were assessed in the meta-analysis. Subsequently, the heterogeneity between studies, sensitivity, publication bias, and meta-regression analyses were performed. Finally, 18 studies, which contained 1,766 participants (922 in the HAIC group and 844 in the SC group) were included. There was a significantly higher OS rate in the HAIC as palliative treatment group (HR, 0.17; 95% CI, 0.08–0.26; P = 0.000) and HAIC as adjuvant treatment group compared with SC group (HR, 0.63; 95% CI, 0.38–0.87; P = 0.000). The complete and partial tumor RRs were also increased significantly in the HAIC as palliative treatment group (RR = 2.09; 95% CI, 1.36–3.22; P = 0.001) and as adjuvant treatment group compared with SC group (RR = 2.14; 95% CI, 1.40–3.26; P = 0.000). However, PFS did not differ significantly between the HAIC and SC groups (P > 0.05). Meta-regression analysis showed potential covariates did not influence on the association between HAIC and OS outcomes (P > 0.05). The results of the present study suggested that HAIC may be a potential therapeutic regimen that may improve the outcomes of patients with CRLM. The present meta-analysis has been registered in PROSPERO (no. CRD 42019145719).
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Affiliation(s)
- Yan Zhang
- The Second Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Kaili Wang
- The Second Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.,China Academy of Chinese Medical Sciences, Beijing, China
| | - Tao Yang
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yibo Cao
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Wanling Liang
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China.,Colorectal and Anal Surgery, Chengdu Anorectal Hospital, Chengdu, China
| | - Xiangdong Yang
- Colorectal and Anal Surgery, Chengdu Anorectal Hospital, Chengdu, China
| | - Tianbao Xiao
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
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5
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Anteby R, Kemeny NE, Kingham TP, D'Angelica MI, Wei AC, Balachandran VP, Drebin JA, Brennan MF, Blumgart LH, Jarnagin WR. Getting Chemotherapy Directly to the Liver: The Historical Evolution of Hepatic Artery Chemotherapy. J Am Coll Surg 2021; 232:332-338. [PMID: 33387624 PMCID: PMC8320676 DOI: 10.1016/j.jamcollsurg.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Roi Anteby
- School of Public Health, Harvard University, Boston, MA; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Nancy E Kemeny
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alice C Wei
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jeffrey A Drebin
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Murray F Brennan
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie H Blumgart
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William R Jarnagin
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Lee BH, Lee DS, Cho CW, Yun SS. Role and limitation of neoadjuvant hepatic arterial infusion chemotherapy in advanced hepatocelluar carcinoma patients with Child-Pugh class A. World J Surg Oncol 2019; 17:143. [PMID: 31416447 PMCID: PMC6694530 DOI: 10.1186/s12957-019-1685-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with advanced hepatocellular carcinoma (HCC) have a poor oncologic outcome. In this study, we evaluated the role and limitation of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients with Child-Pugh class A and the efficacy of liver resection subsequent to downstaging after neoadjuvant HAIC. METHODS In the present retrospective study, 103 patients with advanced HCC, who underwent neoadjuvant HAIC from April 2003 to March 2015 were analyzed. Response to HAIC was evaluated by dividing time period into after 3 cycles and after 6 cycles, each defined as early and late period. Liver resection after neoadjuvant HAIC was offered in patients who were considered as possible candidates for curative resection with tumor-free margin as well as sufficient future liver remnant volume. RESULTS The median survival time (MST) in all patients was 14 ± 1.7 months. Response rate and disease control rate were 36.3% (37) and 81.4% (83) in early period, respectively, and 26.4% (14) and 47.2% (25), in late period, respectively (P = 0.028). Twelve patients (11.7%) underwent liver resection after neoadjuvant HAIC and the MST was 37 ± 6.6 months. One-, 3-, and 5-year recurrence-free survival after liver resection were 58.3%, 36.5%, and 24.3% respectively. Liver resection was identified as the only independent prognostic factor that associated with overall survival in multivariate analysis (P = 0.002) CONCLUSION: HAIC could be further alternative for the treatment of advanced HCC in patients with good liver function. If liver resection is possible after neoadjuvant HAIC, liver resection would provide better outcomes than HAIC alone.
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Affiliation(s)
- Beom-Hui Lee
- Department of Surgery, College of Medicine, Yeungnam University, 170 Hyeonchungno, Nam-gu, Daegu, 42415, Republic of Korea
| | - Dong-Shik Lee
- Department of Surgery, College of Medicine, Yeungnam University, 170 Hyeonchungno, Nam-gu, Daegu, 42415, Republic of Korea
| | - Chan Woo Cho
- Department of Surgery, College of Medicine, Yeungnam University, 170 Hyeonchungno, Nam-gu, Daegu, 42415, Republic of Korea
| | - Sung-Su Yun
- Department of Surgery, College of Medicine, Yeungnam University, 170 Hyeonchungno, Nam-gu, Daegu, 42415, Republic of Korea.
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7
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Oxaliplatin-Based Intra-arterial Chemotherapy in Colo-Rectal Cancer Liver Metastases: A Review from Pharmacology to Clinical Application. Cancers (Basel) 2019; 11:cancers11020141. [PMID: 30682873 PMCID: PMC6406804 DOI: 10.3390/cancers11020141] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023] Open
Abstract
Liver metastases (LM) are often consequences of colo-rectal cancer (CRC)and the majority of patients have unresectable LM. Oxaliplatin-based intravenous chemotherapy represents the gold standard treatment for CRC. Intravenous oxaliplatin has several side effects i.e., nephrologic, hematologic and neurological toxicity. Moreover, hepatic arterial infusion (HAI) of antitumor drugs deeply modifies the treatment of LMCRC due to the knowledge that LM are perfused by the hepatic artery network, whereas healthy tissue is perfused by the portal vein. Therefore, oxaliplatin-based HAI becomes an interesting possibility to treat LMCRC. The aim of this review is to shed light on the important impact of the oxaliplatin-based chemotherapy from a non-conventional clinical point of view, considering that, being universally accepted its antitumor effect if administered intravenously, fragmentary information are known about its clinical applications and benefits deriving from intra-arterial administration in loco-regional chemotherapy.
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8
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Ranieri G, Marech I, Porcelli M, Giotta F, Palmiotti G, Laricchia G, Fazio V, Gadaleta CD. Complete response in a patient with liver metastases from breast cancer employing hepatic arterial infusion 5-fluorouracil based chemotherapy plus systemic nab-paclitaxel. Oncotarget 2017; 9:8197-8203. [PMID: 29487726 PMCID: PMC5814293 DOI: 10.18632/oncotarget.23793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022] Open
Abstract
About half of patients with metastatic breast cancer (mBC) have unresectable liver metastases (LMs) or liver-predominant disease (LPD). Unfortunately systemic chemotherapy has limited tumor response due to LMs are supplied by hepatic artery. Hepatic intra-arterial (HAI) have antitumor activity in pretreated patients with LMs. Here we report the case of a 55-year-old woman affected by BCLPD and heavily pretreated. LMs responded to treatment based on HAI with 5-fluorouracil and nab-paclitaxel systemic chemotherapy, and they completely disappeared on a CT-scan. We conclude that this combination chemotherapy is safe and may be very useful for the treatment of patients with BCLPD. Therefore, this combination should be evaluated in a large study.
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Affiliation(s)
- Girolamo Ranieri
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Ilaria Marech
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Mariangela Porcelli
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Francesco Giotta
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Gennaro Palmiotti
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Giuseppe Laricchia
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Vito Fazio
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari, Italy
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9
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Siqing F, Culotta KS, Falchook GS, Hong DS, Myers AL, Zhang YP, Naing A, Janku F, Hou MM, Kurzrock R. Pharmacokinetic evaluation of nanoparticle albumin-bound paclitaxel delivered via hepatic arterial infusion in patients with predominantly hepatic metastases. Cancer Chemother Pharmacol 2015; 77:357-64. [DOI: 10.1007/s00280-015-2946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
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10
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Regional Arterial Infusion Chemotherapy improves the Pathological Response rate for advanced gastric cancer with Short-term Neoadjuvant Chemotherapy. Sci Rep 2015; 5:17516. [PMID: 26620627 PMCID: PMC4664910 DOI: 10.1038/srep17516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/30/2015] [Indexed: 12/29/2022] Open
Abstract
To identify clinicopathologic and treatment variables that could predict pathologic tumor response to short-term neoadjuvant chemotherapy (NAC) for patients with locally advanced gastric cancer. A retrospective analysis was conducted of 178 patients who underwent short-term NAC with EOX regimen followed by surgery from January 2008 to December 2010. Neoadjuvant treatment response was evaluated using tumor regression grade. Relationships between pathologic tumor response and clinicopathological factors were evaluated using logistic regression analysis. The benefits of regional arterial infusion chemotherapy were investigated separately. The postoperative pathological response rate was 46.1% (82/178) and 4 patients (2.2%) had complete pathological remission. Pathological response was significantly associated with tumor differentiation (P = 0.008), abnormal a-fetoprotein levels (P = 0.01) and administration approach to chemotherapy (intravenous versus regional arterial infusion chemotherapy) (P = 0.018). Most bone marrow toxicities, vomiting, nausea, alopecia, and fatigue were acceptable. Grade 3/4 toxicities were not commonly observed. The 3-year overall survival (OS) and recurrence free survival (RFS) were 67.0% and 53.0%, respectively. Regional arterial infusion NAC group had significantly better median RFS (48.0 versus 34.0 months) than the intravenous NAC group (P = 0.049). In conclusion, regional arterial infusion NAC can improve the pathological response rate of advanced gastric cancer treated with EOX regimen.
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Snyder A, Kemeny N, Shamseddine A, Al-Olayan A, El-Merhi F, Kelsen DP, Jamali F, Sidani M, Mukherji D, El-Naghy M, O'Reilly EM, Saltz LB, Abou-Alfa GK. Liver-directed conversion therapy in metastatic colon cancer. J Gastrointest Oncol 2015; 6:322-8. [PMID: 26029460 DOI: 10.3978/j.issn.2078-6891.2015.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Alexandra Snyder
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Nancy Kemeny
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ali Shamseddine
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ashwaq Al-Olayan
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Fadi El-Merhi
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - David P Kelsen
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Faek Jamali
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Mustafa Sidani
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Deborah Mukherji
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Mahmoud El-Naghy
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Eileen M O'Reilly
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Leonard B Saltz
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ghassan K Abou-Alfa
- 1 Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 American University of Beirut, Beirut, Lebanon ; 4 National Guard Hospital at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
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12
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Retrograde-outflow percutaneous isolated hepatic perfusion using cisplatin: A pilot study on pharmacokinetics and feasibility. Eur Radiol 2014; 25:1631-8. [PMID: 25519978 DOI: 10.1007/s00330-014-3558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate the feasibility and underlying pharmacokinetics of the retrograde-outflow technique for percutaneous isolated hepatic perfusion (PIHP). METHODS Retrograde-outflow PIHP was performed in 12 male pigs (weight, 37-44 kg) by redirecting hepatic outflow through the portal vein. Blood with cisplatin (2.5 mg/kg) in an extracorporeal circuit was circulated through the liver under isolation using rotary pumps with balloon catheters. Hepatic angiographic examinations were conducted during perfusion, and histopathological examinations of the organs were conducted after perfusion. The maximum platinum concentration (C max), area under the concentration-time curve (AUC), and chronologic laboratory data were measured. RESULTS Retrograde-outflow isolated hepatic angiography confirmed that contrast media flowed into the portal veins in all 12 pigs. The hepatic veins and inferior vena cava were not opacified. Hepatic C max (86.3 mg/l) was 39-fold greater than systemic C max (2.2 mg/l), and hepatic AUC (1330.8 min · mg/l) was 30-fold greater than systemic AUC (44.6 min · mg/l). Histopathological examinations revealed no ischaemic changes or other abnormalities in the liver, duodenum, small intestine, or colon. Within 1 week of the procedure, chronologic laboratory data (n = 3) normalized or returned to pre-therapy levels. CONCLUSIONS The retrograde-outflow technique appears to enable safe and feasible PIHP therapy. KEY POINTS • The portal vein acted as an outflow tract under retrograde-outflow PIHP. • Plasma hepatic-to-systemic exposure ratio was 39.2 for the maximum platinum concentration. • Plasma hepatic-to-systemic exposure ratio was 29.8 for the AUC. • The retrograde-outflow technique appears to enable safe and feasible PIHP.
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Butte JM, Ball CG, Dixon E. Treatment of Unresectable Liver-Only Disease: Systemic Therapy versus Locoregional Therapy. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ang C, Jhaveri K, Patel D, Gewirtz A, Seidman A, Kemeny N. Hepatic arterial infusion and systemic chemotherapy for breast cancer liver metastases. Breast J 2012; 19:96-9. [PMID: 23173748 DOI: 10.1111/tbj.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hepatic failure from breast cancer liver metastases (BCLM) is a major cause of morbidity and mortality. We reviewed the treatment histories and outcomes of nine patients with heavily treated BCLM, who received hepatic arterial infusion (HAI) of floxuridine (FUDR)/dexamethasone (Dex) and systemic chemotherapy at our institution. Patients received a median of five (range 1-15) HAI treatments. There were seven (78%) objective responses. Four patients had grade 3 elevations in liver enzymes attributable to HAI. There were no treatment-related deaths. Median hepatic and extrahepatic time to progression on HAI were both 6 months. Median survival after starting HAI was 17 months (range 1-115). Median overall survival from the original breast cancer diagnosis was 110 months (range 52-248). One patient is alive with stable disease on systemic therapy alone. HAI and systemic chemotherapy is feasible and can benefit selected patients with BCLM, who have progressed on prior therapies. Patients require close monitoring for treatment-limiting toxicities.
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Affiliation(s)
- Celina Ang
- Department of Medicine, Gastrointestinal Oncology Service, NY, USA
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15
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Seong NJ, Yoon CJ, Kang SG, Chung JW, Kim HC, Park JH. Effects of arsenic trioxide on radiofrequency ablation of VX2 liver tumor: intraarterial versus intravenous administration. Korean J Radiol 2012; 13:195-201. [PMID: 22438687 PMCID: PMC3303903 DOI: 10.3348/kjr.2012.13.2.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 08/24/2011] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Arsenic trioxide (As(2)O(3)) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow. The aim of this study was to assess the effect of intraarterial and intravenous administration of As(2)O(3) on RF-induced ablation in an experimentally induced liver tumor. MATERIALS AND METHODS VX2 carcinoma was grown in the livers of 30 rabbits. As(2)O(3) (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA ± 35; 90 ± 5℃). As a control group, 10 rabbits were treated with RF ablation alone (group C). RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma. Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. RESULTS The overall ablation areas were 156 ± 28.9 mm(2) (group A), 119 ± 31.7 (group B), and 92 ± 17.4 (group C, p < 0.04). The ablation area of the tumor was significantly larger in group A (73 ± 19.7 mm(2)) than both group B (50 ± 19.4, p = 0.02) and group C (28 ± 2.2, p < 0.01). The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 ± 10.5%) than that of the other groups (42 ± 7.3% in group B and 32 ± 5.6% in group C) (p < 0.03). CONCLUSION Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As(2)O(3). The intraarterial administration of As(2)O(3) seems to be helpful for the selective ablation of the tumor.
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Affiliation(s)
- Nak Jong Seong
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Ito K, Ito H, Kemeny NE, Gonen M, Allen PJ, Paty PB, Fong Y, Dematteo RP, Blumgart LH, Jarnagin WR, D'Angelica MI. Biliary sclerosis after hepatic arterial infusion pump chemotherapy for patients with colorectal cancer liver metastasis: incidence, clinical features, and risk factors. Ann Surg Oncol 2011; 19:1609-17. [PMID: 21989666 DOI: 10.1245/s10434-011-2102-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hepatic arterial infusion pump chemotherapy (HAIPC) contributes to the prolonged survival of selected patients with colorectal cancer liver metastases (CRCLM). The most clinically important adverse event after HAIPC with floxuridine (FUDR) is biliary sclerosis (BS). Little is known about the etiology of BS. METHODS HAIPC was administered to 475 consecutive patients who received HAIPC on prospective protocols from 1991 to 2008. The incidence, clinical features, variables related to demographics, comorbidity, medical history, CRCLM, surgery, chemotherapy, and laboratory data were reviewed. An analysis of factors potentially associated with BS, defined as a biliary stricture related to HAIPC requiring stent placement, was performed. RESULTS The incidence of BS was 5.5% (16 of 293) in patients receiving HAIPC as an adjuvant therapy after hepatectomy, and 2% (2 of 100) in patients receiving HAIPC with FUDR for unresectable disease. The common hepatic duct was the site most frequently affected (87.5%). In patients receiving adjuvant HAIPC, BS was associated with abnormal postoperative flow scans (18.8% vs. 1.8%, P = 0.006), postoperative infectious complications (50.0% vs. 14.8%, P = 0.002), and larger dose/cycle/weight of FUDR (2.6 vs. 2.0 mg/cycle/kg, P = 0.025) than patients without BS. No patient died directly of BS. Median survival was not compromised by the development of BS (BS vs. non-BS: 61.0 months [range 6.2-171.6 months] vs. 47.2 months [range 2.4-200.8 months], P = 0.316, respectively). CONCLUSIONS BS is an uncommon complication after HAIPC and does not compromise survival if adequately salvaged by stenting or dilatation. Surgical complications as well as type and dose of intra-arterial chemotherapy may contribute to the development of BS.
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Affiliation(s)
- Kaori Ito
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Lee HJ, Lee YS, Lee KW, Kim SY, Yoon CJ, Shin DY, Lee YG, Choi SY, Kang SG, Kang SB, Kim JH. Efficacy and safety of hepatic arterial infusion of fluorouracil with leucovorin as salvage treatment for refractory liver metastases from colorectal cancer. Korean J Intern Med 2011; 26:82-8. [PMID: 21437167 PMCID: PMC3056261 DOI: 10.3904/kjim.2011.26.1.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/06/2010] [Accepted: 10/26/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Limited options remain for patients with metastatic colorectal cancer (CRC) after failure of standard systemic chemotherapy. Readministration of chemotherapeutic agents by hepatic arterial infusion (HAI) has the rationale of providing higher concentrations of chemotherapeutic agents to hepatic metastases. The present study was conducted to evaluate the efficacy and safety of HAI of fluorouracil with leucovorin (HAI 5-FU/LV) for patients with liver metastases from CRC. METHODS Fourteen patients with liver metastases from CRC who received HAI 5-FU/LV after failure of systemic chemotherapy containing fluorouracil and leucovorin were identified and their medical records were reviewed. RESULTS Of 10 patients evaluable for response, one partial response, six stable disease, and three progressive disease were reported. Additionally, the overall response and disease control rates were 7% and 50%, respectively. The median time to progression was 4.3 months (range, 2.9 to 5.6), to hepatic progression was 5.8 months (range, 4.7 to 6.9), and to extrahepatic progression was 5.8 months (range, 2.3 to 9.2). No grade 3/4 hematologic toxicities occurred and one case of abdominal pain and two cases of oral mucositis were the only grade 3 nonhematologic toxicities. Catheter-related complications occurred in three patients: one thrombosis, one infection, and one displacement. CONCLUSIONS HAI 5-FU/LV was well tolerated and showed modest efficacy for patients with liver metastases from refractory CRC. Readministration of previously used chemotherapeutic agents via the hepatic artery could be an effective salvage option and warrants further investigation in a prospective trial.
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Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Soo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So Yeon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Gyoo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Gwon Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Power DG, Kemeny NE. Chemotherapy for the conversion of unresectable colorectal cancer liver metastases to resection. Crit Rev Oncol Hematol 2010; 79:251-64. [PMID: 20970353 DOI: 10.1016/j.critrevonc.2010.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 08/01/2010] [Accepted: 08/19/2010] [Indexed: 02/06/2023] Open
Abstract
Resection of colorectal liver metastases (CLM) is the ultimate aim of treatment strategies in most patients with liver-confined metastatic colorectal cancer. Long-term survival is possible in selected patients with initially resectable or unresectable CLM. As a majority of patients have unresectable liver disease at the outset, there is a clear role for chemotherapy to downstage liver disease making resection possible. Studies of systemic chemotherapy with or without biologic therapy in patients with unresectable CLM have resulted in increased response rates, liver resection rates and survival. A sound physiologic rationale exists for the use of hepatic arterial infusion (HAI) therapy. Studies have shown that HAI with floxuridine combined with systemic chemotherapy increases response rates and liver resection rates in those patients with initially unresectable CLM. Toxicity from preoperative chemotherapy, biologic therapy and HAI therapy may adversely affect hepatic resection but can be kept minimal with appropriate monitoring. All conversion strategies should be decided by a multidisciplinary team.
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Affiliation(s)
- Derek G Power
- Department of Medicine, Gastrointestinal Oncology Division, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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19
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Tsimberidou AM, Fu S, Ng C, Lim JA, Wen S, Hong D, Wheler J, Bedikian AY, Eng C, Wallace M, Camacho LH, Kurzrock R. A phase 1 study of hepatic arterial infusion of oxaliplatin in combination with systemic 5-fluorouracil, leucovorin, and bevacizumab in patients with advanced solid tumors metastatic to the liver. Cancer 2010; 116:4086-94. [PMID: 20564148 DOI: 10.1002/cncr.25277] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Liver metastases in patients with cancer are associated with poor survival. The authors of this report conducted a phase 1 study of hepatic arterial infusion (HAI) oxaliplatin combination therapy in patients with advanced cancer and liver metastases. METHODS Treatment consisted of escalating doses of HAI oxaliplatin 60 mg/m(2) to 175 mg/m(2) and intra-arterial heparin 3000 IU (Day 1); leucovorin 200 mg/m(2) intravenously (iv) and 5-fluorouracil 300 mg/m(2) bolus plus 600 mg/m(2) iv (Days 1 and 2); and bevacizumab 10 mg/kg iv (Day 3). A conventional "3 + 3" design was used. RESULTS Fifty-seven patients were treated, including 30 women and 27 men. The median age was 57 years, and the patients had received a median of 3 prior therapies (range, 1-7 prior therapies). The most common cancer was colorectal (n = 29). Overall, 204 cycles were administered (median per patient, 2 cycles; range, 1-17 cycles). The maximum tolerated dose (MTD) of HAI oxaliplatin was 140 mg/m(2). Dose-limiting toxicities were grade 4 thrombocytopenia (n = 1) and grade 4 hypokalemia (n = 1) at 150 mg/m(2) (n = 5). Thirty-three patients (58%) had no toxicity greater than grade 1. The most common toxicities were thrombocytopenia (n = 19), fatigue (n = 15), nausea/vomiting (n = 6), constipation (n = 6), and diarrhea (n = 4). Of 55 patients who were evaluable for response (according to Response Evaluation Criteria in Solid Tumors), 4 patients (7%) had a partial response (PR), and 32 patients (58%) had stable disease (SD), including 15 patients (48%) who had SD for >/=4 months. Of 28 patients with colorectal cancer, 3 patients (11%) had a PR, and 9 patients (32%) had SD for >/=4 months. CONCLUSIONS HAI oxaliplatin combined with systemic 5-fluorouracil, leucovorin, and bevacizumab had antitumor activity in patients with advanced cancer and liver metastases, and the current results indicated that this combination warrants further study. Cancer 2010. (c) 2010 American Cancer Society.
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Affiliation(s)
- Apostolia M Tsimberidou
- Phase I Program, Department of Investigational Cancer Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Pwint TP, Midgley R, Kerr DJ. Regional hepatic chemotherapies in the treatment of colorectal cancer metastases to the liver. Semin Oncol 2010; 37:149-59. [PMID: 20494707 DOI: 10.1053/j.seminoncol.2010.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The liver is the most common site of metastatic spread of colorectal cancer (CRC). Liver may be the only site of spread in as many as 30% to 40% of patients with advanced disease and can be treated with regional therapies directed toward their liver tumors. Surgery is currently the only potentially curative treatment, with a 5-year survival rate as high as 30% to 40% in selected patients. However, fewer than 25% of cases are candidates for curative resection. A number of other locoregional therapies, such as radiofrequency or microwave ablation, cryotherapy, and chemotherapy, may be offered to patients with unresectable but isolated liver metastases. However, for most patients with metastatic spread beyond the liver, systemic chemotherapy rather than regional therapy is a more appropriate option. We review the status of various regional hepatic chemotherapies in the treatment of colorectal metastases to the liver in the light of the available, published prospective, randomized trials; this discipline has not yet been properly applied to the burgeoning use of locally ablative techniques. The regional strategies reviewed include portal venous infusion (PVI) of 5-fluorouracil (5-FU), intra-arterial chemotherapy (hepatic arterial infusion [HAI]), chemoembolization, and selective internal radiation therapy (SIRT).
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Affiliation(s)
- Thinn P Pwint
- Medical Oncology Unit, Churchill Hospital, Oxford, UK.
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21
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Power DG, Kemeny NE. Role of adjuvant therapy after resection of colorectal cancer liver metastases. J Clin Oncol 2010; 28:2300-9. [PMID: 20368552 DOI: 10.1200/jco.2009.26.9340] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Liver resection is the goal of treatment strategies for liver-confined metastatic colorectal cancer. However, after resection the majority of patients will experience recurrence. Chemotherapy seems to improve outcomes compared with surgery alone. We reviewed the data of the role of adjuvant chemotherapy after resection of liver- confined metastatic colorectal cancer. Optimal regimens and sequencing of chemotherapies when liver resection is an option are unclear. Some suggest that resectable liver metastases, in the absence of high-risk features, should begin with surgery and consideration given to adjuvant chemotherapy after surgery. If high-risk features are present, most physicians prefer a short course of systemic preoperative chemotherapy. Perioperative therapy and regional therapy with hepatic arterial infusion (HAI) both increase disease-free survival (DFS) when compared with surgery alone. In unresectable disease, consideration should be given to systemic chemotherapy with or without a biologic agent or HAI with systemic therapy. If the disease becomes resectable, adjuvant treatment should follow surgery. Adjuvant chemotherapy is usually FOLFOX, but HAI combined with systemic chemotherapy is also an option. The role of adjuvant treatment post-liver resection should not be viewed in isolation but rather in the context of prior treatment, surgical preference, and individual patient characteristics. Perioperative therapy and regional therapy have both shown an increase in DFS. Conducting randomized trials examining the role of adjuvant chemotherapy has been difficult because of rapidly changing chemotherapies.
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Affiliation(s)
- Derek G Power
- Department of Medicine, Gastrointestinal Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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Phase I clinical trial of hepatic arterial infusion of cisplatin in combination with intravenous liposomal doxorubicin in patients with advanced cancer and dominant liver involvement. Cancer Chemother Pharmacol 2010; 66:1087-93. [PMID: 20204368 DOI: 10.1007/s00280-010-1266-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 02/01/2010] [Indexed: 01/24/2023]
Abstract
PURPOSE We conducted a phase I study of hepatic arterial infusion (HAI) cisplatin and systemic chemotherapy in patients with advanced cancer and dominant liver involvement. METHODS Patients were treated with HAI cisplatin 100-125 mg/m(2) (and 3,000 IU heparin) intraarterially and liposomal doxorubicin (doxil) 20-35 mg/m(2) IV (day 1) every 28 days. A "3 + 3" study design was used. RESULTS Thirty patients were treated (median age, 56 years). Diagnoses were breast cancer (n = 11), colorectal cancer (n = 8), ocular melanoma (n = 4), and other (n = 7). The median number of prior therapies was 5. The maximum tolerated dose (MTD) was at the 100/35 mg/m(2) level. Dose-limiting toxicities were Grade 4 neutropenia (2 of 4 patients), and Grade 4 thrombocytopenia (n = 1) at the cisplatin 125 mg/m(2) and systemic doxil 35 mg/m(2) dose level. The most common toxicities were nausea/vomiting and fatigue. Of 24 patients evaluable for response, 4 (17%) had a partial response (PR) and 7 (29%) had stable disease (SD) for ≥4 months. Of the 11 patients with breast cancer, 3 (27%) had a PR and 5 (45%) had SD for ≥4 months. Of 4 patients with ocular melanoma, 1 had a PR and 1 SD for 4 months. One patient with hepatocellular carcinoma had SD for 4 months. Of 12 evaluable patients treated at the MTD, 2 (17%) had a PR and 5 (42%) had SD. CONCLUSION The MTD was HAI cisplatin 100 mg/m(2) and systemic doxil 35 mg/m(2). This regimen demonstrated antitumor activity, especially in breast cancer.
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Mocellin S, Pasquali S, Nitti D. Fluoropyrimidine-HAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer. Cochrane Database Syst Rev 2009:CD007823. [PMID: 19588444 DOI: 10.1002/14651858.cd007823.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although locoregional treatments such as hepatic arterial infusion (HAI) claim the advantage of delivering higher doses of anticancer agents directly into the metastatic organ as compared to systemic chemotherapy (SCT), the benefit in terms of overall survival (OS) is unclear. We quantitatively summarized the results of randomised controlled trials (RCT) comparing HAI to SCT for the treatment of unresectable liver metastatic disease from colorectal cancer (CRC). OBJECTIVES The aim of this work is to quantitatively summarize the results of RCT comparing HAI to SCT for the treatment of unresectable hepatic metastases from CRC. SEARCH STRATEGY A systematic review of reports published until September 2008 on the findings of RCT that compared HAI to SCT for the treatment of unresectable CRC liver metastases was performed by searching the MEDLINE, Embase, Cancerlit, Cochrane and GoogleScholar electronic databases as well as other databanks collecting information on clinical trials. SELECTION CRITERIA Inclusion criteria were patients with unresectable CRC liver metastases enrolled in RCT comparing HAI to SCT. The outcome measures were tumor response rate and overall survival. DATA COLLECTION AND ANALYSIS Two authors independently carried out study selection and assessment of methodological quality. A third author performed a concordance analysis in order to unravel potential systematic biases. MAIN RESULTS Ten RCT were identified that met the eligibility criteria. HAI regimens were based on floxuridine (FUDR), 5-fluorouracil or either one of these two fluoropyrimidines in eight and one RCT, respectively. SCT consisted of FUDR or 5-fluorouracil in three and seven RCT, respectively. By pooling the summary data, tumor response rate resulted 42.9% and 18.4% for HAI and SCT, respectively (RR = 2.26; 95% CI, 1.80 to 2.84; P < 0.0001). Mean weighted median OS times were 15.9 and 12.4 months for HAI and SCT, respectively: the meta-risk of death was not statistically different between the two treatment groups (HR = 0.90; 95% CI, 0.76 to 1.07; P = 0.24). AUTHORS' CONCLUSIONS Currently available evidence does not support the clinical or investigational use of fluoropyrimidine-based HAI alone for the treatment of patients with unresectable CRC liver metastases: in fact, the greater tumor response rate obtained with this HAI regimen does not translate into a survival advantage over fluoropyrimidine alone SCT.
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Affiliation(s)
- Simone Mocellin
- Departement of Oncological & Surgical Sciences, University of Padova, Via Giustiniani 2, Padova, Veneto, Italy, 35128
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Verhoef C, de Wilt JHW, ten Hagen TLM, Eggermont AMM. Isolated hepatic perfusion for the treatment of liver tumors: sunset or sunrise? Surg Oncol Clin N Am 2008; 17:877-94, xi. [PMID: 18722924 DOI: 10.1016/j.soc.2008.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Experience with isolated hepatic perfusion (IHP) is limited to a few centers in the world because of the technical difficulties, surgery-related morbidity, and unproved efficacy in randomized trials. Experimental animal IHP models have led to exploring new ways of improving efficacy, reducing technical difficulties, and minimizing regional and systemic toxicity. Future research should be directed to the identification of suitable biologic or chemotherapeutic agents, defining clinical indications, and development of technical modifications to make it more generally applicable and even repeatable.
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Affiliation(s)
- Cornelis Verhoef
- Department of Surgical Oncology, Erasmus University Medical Centre-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
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Power DG, Healey-Bird BR, Kemeny NE. Regional Chemotherapy for Liver-Limited Metastatic Colorectal Cancer. Clin Colorectal Cancer 2008; 7:247-59. [DOI: 10.3816/ccc.2008.n.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Mocellin S, Nitti D. In Reply. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.17.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Simone Mocellin
- Surgery Branch, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
| | - Donato Nitti
- Surgery Branch, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
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Verhoef C, de Wilt JHW, Brunstein F, Marinelli AWKS, van Etten B, Vermaas M, Guetens G, de Boeck G, de Bruijn EA, Eggermont AMM. Isolated hypoxic hepatic perfusion with retrograde outflow in patients with irresectable liver metastases; a new simplified technique in isolated hepatic perfusion. Ann Surg Oncol 2008; 15:1367-74. [PMID: 18239976 PMCID: PMC2277449 DOI: 10.1245/s10434-007-9714-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 10/30/2007] [Accepted: 10/31/2007] [Indexed: 12/16/2022]
Abstract
Background Isolated hepatic perfusion with high-dose chemotherapy is a treatment option for patients with irresectable metastases confined to the liver. Prolonged local control and impact on survival have been claimed. Major drawbacks are magnitude and costs of the procedure. We developed an isolated hypoxic hepatic perfusion (IHHP) with retrograde outflow without the need for a heart-lung machine. Patients and Methods Twenty-four consecutive patients with irresectable metastases of various origins were treated. IHHP inflow was via the hepatic artery, outflow via the portal vein with occlusion of the retrohepatic caval vein. Radiolabeled albumine was used for leakage monitoring. Melphalan was used at 1–2 mg/kg. A 25-minute perfusion period was followed by a complete washout. Local and systemic melphalan concentrations were determined. Results Compared with oxygenated classical IHP, the IHPP procedure reduced operation time from >8 h to 4 hours, blood loss from >4000 to 900 cc and saved material and personnel costs. Leakage was 0% with negligible systemic toxicity and 0% perioperative mortality. Tumor response: complete response (CR) in 4%, partial response (PR) in 58%, and stable disease (SD) in 13%. Median time to progression was 9 months (2–24 months); pharmacokinetics demonstrated intrahepatic melphalan concentrations more than 9 fold higher than postperfusion systemic concentrations. Conclusions IHPP is a relatively simple procedure with reduced costs, reduced blood loss, no mortality, limited toxicity, and response rates comparable to classic IHP. The median duration of 9 months of tumor control should be improved. Hereto, vasoactive drugs, will be explored in further studies.
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Affiliation(s)
- Cornelis Verhoef
- Department of Surgical Oncology, Erasmus University Medical Centre-Daniel den Hoed Cancer Centre, PO Box 5201, 3008 AE, Rotterdam, The Netherlands.
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Mocellin S, Pilati P, Lise M, Nitti D. Meta-analysis of hepatic arterial infusion for unresectable liver metastases from colorectal cancer: the end of an era? J Clin Oncol 2007; 25:5649-54. [PMID: 18065736 DOI: 10.1200/jco.2007.12.1764] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The treatment of unresectable liver-confined metastatic disease from colorectal cancer (CRC) is a challenging issue. Although locoregional treatments such as hepatic arterial infusion (HAI) claim the advantage of delivering higher doses of anticancer agents directly into the affected organ, the benefit in terms of overall survival (OS) is unclear. We quantitatively summarized the results of randomized controlled trials (RCT) comparing HAI with systemic chemotherapy (SCT). METHODS To date, 10 RCTs have been published, for a total of 1,277 patients enrolled. For tumor response rates, relative risks (RR) and their 95% CIs were obtained from raw data; for OS, hazard ratios (HRs) and their 95% CIs were extrapolated from the Kaplan-Meier survival curves. RESULTS HAI regimens were based on floxuridine (FUDR) in nine of 10 RCTs, whereas in one RCT, fluorouracil (FU) + leucovorin was used. SCT consisted of FUDR, FU, FU + leucovorin, or a miscellany of FU and best supportive care in three, one, four, and two studies, respectively. Pooling the data, tumor response rate was 42.9% and 18.4% for HAI and SCT, respectively (RR = 2.26; 95% CI, 1.80 to 2.84; P < .0001). Mean weighted median OS times were 15.9 and 12.4 months for HAI and SCT, respectively; the meta-risk of death was not statistically different between the two study groups (HR = 0.90; 95% CI, 0.76 to 1.07; P = .24). CONCLUSION Currently available evidence does not support the clinical or investigational use of fluoropyrimidine-based HAI alone for the treatment of patients with unresectable CRC liver metastases, at least as a first-line therapy.
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Affiliation(s)
- Simone Mocellin
- Clinica Chirurgica Generale 2, Department of Oncological and Surgical Sciences, University of Padova, via Giustiniani 2, 35128 Padova, Italy.
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Hagle ME. III. Arterial Access Devices. Clin J Oncol Nurs 2007. [DOI: 10.1188/03.cjon.669-674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mocellin S, Pilati P, Da Pian P, Forlin M, Corazzina S, Rossi CR, Innocente F, Ori C, Casara D, Ujka F, Nitti D, Lise M. Correlation between melphalan pharmacokinetics and hepatic toxicity following hyperthermic isolated liver perfusion for unresectable metastatic disease. Ann Surg Oncol 2006; 14:802-9. [PMID: 17103263 DOI: 10.1245/s10434-006-9108-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 05/23/2006] [Accepted: 05/23/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the present work, we report on the results of our pilot study of hyperthermic isolated hepatic perfusion (IHP) with melphalan alone for patients with unresectable metastatic liver tumors refractory to conventional treatments, with particular regard to the correlation between pharmacokinetic findings and hepatic toxicity. PATIENTS AND METHODS Inclusion criteria were unresectable liver metastases, hepatic parenchyma replacement <or=50%, normal liver function, and previous failure of at least one conventional treatment. IHP was performed under hyperthermic conditions with melphalan (1.5 mg/kg body weight). Completeness of vascular isolation of the liver and drug distribution volumes of the perfusion circuit were assessed by a radiolabeled albumin-based method. Drug concentrations in perfusate and plasma were measured by means of high-performance liquid chromatography (HPLC). RESULTS Twenty patients with unresectable liver metastases underwent IHP. No intraoperative mortality occurred. Treatment-related systemic toxicity was minimal and reversible. Three patients (15%) experienced grade 4 hepatic toxicity and died due to liver failure and subsequent multiorgan failure. Other six patients had significant (grade 3-4) but transitory hepatic toxicity. Complete and partial responses were observed in three and nine out of 17 evaluable patients, respectively (overall response rate = 70%). The pharmacokinetics study showed a 3% mean perfusate-to-plasma drug leakage (range 1-6%). Logistic regression analysis showed that drug concentration in the perfusate circuit, but not preoperative tests, significantly and independently correlated with hepatic toxicity (P = 0.028). CONCLUSIONS Following melphalan-based IHP, objective tumor regression could be observed in a remarkable percentage of patients refractory to standard treatments. However, hepatic toxicity and related mortality were significant. Our findings suggest that drug dosage personalization based on the measurement of drug distribution volumes might minimize hepatic toxicity.
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Affiliation(s)
- Simone Mocellin
- Surgery Branch, Department of Oncological and Surgical Sciences, University of Padova, via Giustiniani 2, 35128, Padova, Italy
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Cohen SJ, Alpaugh RK, Gross S, O'Hara SM, Smirnov DA, Terstappen LWMM, Allard WJ, Bilbee M, Cheng JD, Hoffman JP, Lewis NL, Pellegrino A, Rogatko A, Sigurdson E, Wang H, Watson JC, Weiner LM, Meropol NJ. Isolation and characterization of circulating tumor cells in patients with metastatic colorectal cancer. Clin Colorectal Cancer 2006; 6:125-32. [PMID: 16945168 DOI: 10.3816/ccc.2006.n.029] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Development of targeted therapeutic agents in colorectal cancer (CRC) is impeded by the lack of a noninvasive surrogate of drug effect. This pilot study evaluated the ability of immunomagnetic separation to isolate circulating tumor cells (CTCs) and of the fluorescent microscope system and flow cytometry to enumerate and characterize CTCs from patients with metastatic CRC. PATIENTS AND METHODS Fifty patients with metastatic CRC contributed 50 mL of blood at treatment initiation and disease evaluation timepoints. Fresh tumor specimens were obtained from 17 patients for comparison of circulating and in situ tumor cell characteristics. Epithelial cells were magnetically isolated from whole blood targeting the antiepithelial cell adhesion molecule (EpCAM). Circulating tumor cells were defined as EpCAM isolated, cytokeratin positive, nuclear stain positive, and CD45 negative. Total RNA was isolated from EpCAM-enriched CTCs and multigene reverse-transcriptase polymerase chain reaction analyses were performed. RESULTS The median number of CTCs detected by flow cytometry was 2/7.5 mL blood. Mean change in cell count was significantly different for patients with tumor progression versus nonprogression (+6.7 vs. +0.2/7.5 mL; P = 0.001). A correlation was noted between mean fluorescence intensity (flow cytometry) of cytokeratin in CTC and matched tumor specimens (r = 0.79, P = 0.06). Nearly 80% (15 of 19) of samples with >or= 2 CTCs expressed >or= 1 epithelial marker gene (CK19, CK20, carcinoembryonic antigen, or epidermal growth factor receptor). CONCLUSION Isolating and characterizing CTCs from patients with metastatic CRC is feasible. Change in the CTC number might reflect clinical status, and flow cytometric and gene expression data suggest similarity of circulating and in situ tumor cells. Further evaluation of CTCs for pharmacodynamic and clinical monitoring in patients with CRC is warranted.
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Affiliation(s)
- Steven J Cohen
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA.
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Tentes AAK, Markakidis SK, Karanikiotis C, Fiska A, Tentes IK, Manolopoulos VG, Dimitriou T. Intraarterial chemotherapy as an adjuvant treatment in locally advanced gastric cancer. Langenbecks Arch Surg 2006; 391:124-9. [PMID: 16534653 DOI: 10.1007/s00423-006-0022-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS D2 gastrectomy has improved survival in gastric cancer. Adjuvant intravenous chemotherapy, radiotherapy, or multimodal therapy has failed to demonstrate improved survival. The results of intraarterial chemotherapy (IARC) as an adjuvant have been encouraging in a few studies. A prospective randomized trial was designed to evaluate the toxicity and survival in locally advanced gastric cancer using IARC as an adjuvant after potentially curative gastrectomy. PATIENTS AND METHODS Forty patients with locally advanced gastric cancer were randomly selected to undergo either potentially curative gastrectomy and receive IARC (study group) or gastrectomy only (control group). Clinical and histopathologic data were analyzed and the toxicity related to IARC was recorded. RESULTS The groups were comparable (p>0.05). Three patients in the study group had minor toxicity. Five-year survival rate for the study and the control group was 52 and 54%, respectively (p>0.05). Mean survival for the study and the control group was 50+/-8 and 62+/-10 months, respectively (p>0.05). The number of recurrences and the failure sites were comparable (p>0.05). CONCLUSION Intraarterial chemotherapy can be safely applied to gastric cancer patients. As proposed by the protocol, the method cannot be recommended as an adjuvant treatment for locally advanced tumors because it appears that there is no survival benefit compared to potentially curative gastrectomy alone.
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van Ijken MGA, van Etten B, Brunstein F, ten Hagen TLM, Guetens G, de Wilt JHW, de Bruijn EA, Eggermont AMM. Bio-chemotherapeutic strategies and the (dis) utility of hypoxic perfusion of liver, abdomen and pelvis using balloon catheter techniques. Eur J Surg Oncol 2005; 31:807-16. [PMID: 15951150 DOI: 10.1016/j.ejso.2005.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 02/03/2005] [Accepted: 02/14/2005] [Indexed: 01/07/2023] Open
Abstract
AIMS To review the development and current status of balloon catheter mediated hypoxic perfusion of abdomen, pelvis and liver for treatment of locally advanced malignancies. Within this context we focus on the addition of tumour necrosis factor-alpha (TNF) to these minimal invasive perfusion procedures. METHODS A literature search on these topics was carried out in PubMed for indexed articles and in all issues of Regional Cancer Treatment. The findings were related to our own experiences. RESULTS Hypoxic abdominal (HAP) and hypoxic pelvic perfusion (HPP) using balloon catheters, are currently applied modalities for treatment of a wide variety of abdominal and pelvic tumours, yet scientific validation of these procedures is poor. Following the results of several Phase I-II trials, both treatments are associated with severe systemic toxicity, significant morbidity and even mortality. The degree of systemic leakage associated with these procedures prohibits addition of TNF. For leakage free liver perfusion surgery is still required, as with current balloon catheter techniques it is not possible to perform leakage free isolated hypoxic hepatic perfusion (IHHP), using either orthograde or retrograde hepatic flow. Experimental and clinical observations suggest that within any perfusion setting, the utilization of TNF is only indicated for treatment of highly vascularised tumours and not for treatment of colorectal tumours. CONCLUSION Balloon catheter technology in its present form does not provide adequate leakage control in any of these settings and is therefore associated with considerable toxicity. It is associated with poor response rates and cannot be considered in any setting as a standard of care.
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Affiliation(s)
- M G A van Ijken
- Department of Surgical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
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Glasgow SC, Chapman WC. Emerging Technology in the Treatment of Colorectal Metastases to the Liver. SEMINARS IN COLON AND RECTAL SURGERY 2005. [DOI: 10.1053/j.scrs.2005.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Richter S, Pistorius G, Seidel R, Feifel G, Schilling MK, Vollmar B, Menger MD. Arteriolovenular Shunting Critically Determines Shutdown of Microcirculation Upon Cryotherapy in Tumor-Bearing Rat Liver. Ann Surg Oncol 2005; 12:303-12. [PMID: 15827680 DOI: 10.1245/aso.2005.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Accepted: 11/29/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tissue destruction by cryosurgery not only is mediated by direct cell damage, but also involves secondary mechanisms, such as ischemia due to shutdown of the microcirculation. Clinicians favor repetitive cryoapplication, although there is no proven evidence for a more effective tumor eradication. METHODS The aims of this study were (1) to establish a rat liver tumor model that allows for intravital microscopic analysis of hepatic tumor microcirculation and (2) to elucidate critical determinants of shutdown of microvascular perfusion after single and repetitive cryotherapy. In WAG-Rji rats (n = 14), syngeneic colon carcinoma cells (CC531) were implanted into the left liver lobe. Hepatic and tumor microcirculation were studied by intravital microscopy. RESULTS Two weeks after implantation, the tumors had developed a microvasculature with a capillary density markedly (P < .05) lower compared with the sinusoidal density of normal liver. However, at the tumor margin, venule diameters were significantly enlarged (P < .05), with high red blood cell velocities and arteriolovenular shunts. Both freeze procedures (temperature at the tumor margin: -32.4 degrees C +/- 1.6 degrees C and -36.4 degrees C +/- 2.0 degrees C) resulted in a complete shutdown of intratumoral and peritumoral capillary and hepatic sinusoidal perfusion. In contrast, some large venules showed maintenance of blood flow initially after freezing (15 minutes); however, this was abolished during the subsequent 2-hour observation period. CONCLUSIONS Enlarged high-flow venules at the tumor margin, which participate in arteriolovenular shunting, critically determine the shutdown of the microcirculation upon cryotherapy. Repetitive freezing is not more effective than a single-freeze procedure to achieve complete tumor microcirculatory stasis.
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Affiliation(s)
- Sven Richter
- Department for General, Visceral, and Vascular Surgery, University of Saarland, D-66421, Homburg/Saar, Germany
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Cocconi G, Gamboni A, Gasparro D, Leonardi F, Salvagni S, Vasini G, Larini P, Marcato C, Camisa R, Cascinu S. Hepatic Artery Administration of Docetaxel in Liver Metastases from Breast Carcinoma: A Feasibility Study. TUMORI JOURNAL 2005; 91:121-5. [PMID: 15948537 DOI: 10.1177/030089160509100203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Taxanes are largely metabolized and almost exclusively excreted in the feces by the liver through the biliary pathway, thus providing a rationale for investigating the activity of their hepatic artery delivery in case of liver metastases. Study design The aim of this study was to assess the feasibility of administering docetaxel via the hepatic artery in advanced breast cancer patients in whom the liver was the only or the predominant site of metastatic involvement. The dose was increased cycle by cycle in a prospective manner. Results Ten eligible patients were enrolled. The median administered dose in the last cycle was 65 mg/m2 (range, 40-100 mg/m2). The treatment was generally well tolerated, and only one patient stopped after two cycles because of toxicity. Four of the 9 eligible patients with assessable liver tumors achieved an objective response. After a median follow-up of 41 months, 4 of the 10 eligible (and 11 treated) patients were alive with a median overall survival of 46 months. Conclusions The administration of docetaxel via the hepatic artery is feasible. The highly interesting response and survival results observed in this limited series of patients warrant further studies.
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Affiliation(s)
- Giorgio Cocconi
- Medical Oncology Division, Azienda Ospedaliera, Parma, Italy.
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Alexander HR, Libutti SK, Pingpank JF, Bartlett DL, Helsabeck C, Beresneva T. Isolated hepatic perfusion for the treatment of patients with colorectal cancer liver metastases after irinotecan-based therapy. Ann Surg Oncol 2005; 12:138-44. [PMID: 15827794 DOI: 10.1245/aso.2005.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 11/01/2004] [Indexed: 01/02/2023]
Abstract
BACKGROUND Irinotecan given with 5-fluorouracil and leucovorin is currently used as first-line therapy for patients with metastatic colorectal cancer (CRC). However, the response duration is <1 year, and second-line systemic chemotherapy has limited efficacy. We analyzed the efficacy of isolated hepatic perfusion (IHP) for patients with progressive CRC liver metastases after irinotecan. METHODS Between March 1993 and February 2003, 124 patients with CRC liver metastases underwent IHP on institutional review board-approved protocols. The overall treatment mortality was 4% (5 of 124). Twenty-five patients (10 women and 15 men; mean age, 53 years) were identified who had progressive liver metastases by carcinoembryonic antigen, imaging studies, or both after irinotecan. A 1-hour hyperthermic IHP (mean hepatic temperature, 40.0 degrees C) with melphalan 1.5 mg/kg (mean total dose, 100 mg) was administered via laparotomy. Perfusion with an oxygenated extracorporeal circuit was established with inflow via a cannula in the gastroduodenal artery and common hepatic artery inflow occlusion. Outflow was via a cannula in an isolated segment of the inferior vena cava. During IHP, portal and inferior vena caval flow were shunted to the axillary vein. Patients were assessed for radiographical response, recurrence pattern, and survival. RESULTS The mean number of prior irinotecan cycles in 25 patients was 6 (range, 2-14), and it was given primarily as second-line therapy. The median number of liver metastases before IHP was 10 (range, 1-50), and the median percentage of hepatic replacement by tumor was 25%. The mean operative time was 9 hours (range, 6-12 hours), and the median hospital stay was 11 days (range, 8-76 days). There was 1 complete response and there were 14 partial responses in 25 patients (60%), with a median duration of 12 months (range, 5-35 months). Disease progressed systemically in 13 of 25 patients at a median of 5 months (range, 3-16 months). The median overall survival was 12 months (range, 1-47 months), and the 2-year survival was 28%. CONCLUSIONS For patients with progressive CRC liver metastases after irinotecan, IHP has good efficacy in terms of response rate and duration. Continued evaluation of IHP with melphalan as second-line therapy in this clinical setting is justified.
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Affiliation(s)
- H Richard Alexander
- Surgical Metabolism Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, Maryland 20892-1502, USA.
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van Etten B, Brunstein F, van IJken MGA, Marinelli AWKS, Verhoef C, van der Sijp JRM, Guetens G, de Boeck G, de Bruijn EA, de Wilt JHW, Eggermont AMM. Isolated hypoxic hepatic perfusion with orthograde or retrograde flow in patients with irresectable liver metastases using percutaneous balloon catheter techniques: a phase I and II study. Ann Surg Oncol 2004; 11:598-605. [PMID: 15172933 DOI: 10.1245/aso.2004.09.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated hepatic perfusion for irresectable metastases confined to the liver has reported response rates of 50% to 75%. Magnitude, costs, and nonrepeatability of the procedure are its major drawbacks. We developed a less invasive, less costly, and potentially repeatable balloon catheter-mediated isolated hypoxic hepatic perfusion (IHHP) technique. METHODS In this phase I and II study, 18 consecutive patients with irresectable colorectal or ocular melanoma hepatic metastases were included. Two different perfusion methods were used, both with inflow via the hepatic artery, using melphalan 1 mg/kg. In the first eight patients, the portal vein was occluded, and outflow was via the hepatic veins into an intracaval double-balloon catheter. This orthograde IHHP had on average 56% leakage. In next 10 patients, we performed a retrograde outflow IHHP with a triple balloon blocking outflow into the caval vein and allowing outflow via the portal vein. The retrograde IHHP still had 35% leakage on average. RESULTS Although local drug concentrations were high with retrograde IHHP, systemic toxicity was still moderate to severe. Partial responses were seen in 12% and stable disease in 81% of patients. The median time to local progression was 4.8 months. CONCLUSIONS We have abandoned occlusion balloon methodology for IHHP because it failed to obtain leakage control. We are presently conducting a study using a simplified surgical retrograde IHHP method, in which leakage is fully controlled, which translates into high response rates.
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Affiliation(s)
- Boudewijn van Etten
- Department of Surgical Oncology, Erasmus University Medical Center-Daniel den Hoed Cancer Center, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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Barber FD, Mavligit G, Kurzrock R. Hepatic arterial infusion chemotherapy for metastatic colorectal cancer: a concise overview. Cancer Treat Rev 2004; 30:425-36. [PMID: 15245775 DOI: 10.1016/j.ctrv.2004.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with colorectal cancer commonly succumb to the sequelae of hepatic metastases. Response to systemic therapy is inadequate. Hepatic arterial infusion (HAI) exposes liver metastases to high local concentrations of drug. Herein, we review the randomized trials of HAI in colorectal cancer. Data for this review were identified by searches of MEDLINE and references from relevant articles using the search terms "infusion intra-arterial" and "colorectal cancer." Abstracts and reports from meetings were included only when they related directly to previously published work. Only papers published in English between 1966 and 2003 were included. Randomized trials (5-fluorouracil- (5-FU-) or fluordeoxyuridine- (FUDR-) based regimens) often demonstrated superior response rates for HAI as compared to systemic chemotherapy (primary treatment or post-resection). Enhanced survival has, however, shown only when HAI was combined with systemic chemotherapy in the post-resection setting. For 5-FU-based and perhaps other regimens, randomized trials of combined regional and systemic therapy versus systemic treatment alone may be needed in order to determine whether or not there is a survival advantage after HAI in unresectable patients, as has been recently demonstrated in resectable patients. A variety of agents other than 5-FU have also been given by HAI to patients with liver metastases from diverse cancers. Such regional therapy often yields encouraging response rates and impact on survival therefore merits investigation.
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Affiliation(s)
- Fedricker D Barber
- Department of Bioimmunotherapy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 422, Houston, TX 77030, USA
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Cheng J, Hong D, Zhu G, Swanstrom LL, Hansen PD. Laparoscopic Placement of Hepatic Artery Infusion Pumps: Technical Considerations and Early Results. Ann Surg Oncol 2004; 11:589-97. [PMID: 15150068 DOI: 10.1245/aso.2004.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic hepatic artery infusion pump (LHAIP) placement is a novel treatment option for patients with colorectal liver metastases. This study investigates technical difficulties with regard to variant hepatic arteries and the preliminary outcomes for patients treated with LHAIP placement. METHODS Between March 1998 and January 2003, 38 patients with colorectal metastases confined to the liver, 35 (92%) of who had prior systemic chemotherapy that failed, were treated with LHAIP. RESULTS Twelve patients (32%) had LHAIP placement only, and 26 (68%) had pump placement combined with laparoscopic radiofrequency ablation (LRFA; 24 patients) and/or liver resection (2 patients). Variant hepatic arterial (HA) anatomy was present in 18 patients (47%). The presence of a variant HA did not increase pump complications, operative time, or blood loss (P >/=.20) or decrease the functional time of pump use (P =.91) in comparison with normal anatomy. In all patients with a variant HA, laparoscopic ligation of the variant vessel and/or cannulation of nongastroduodenal artery resulted in complete hepatic perfusion. Three misperfusions identified intraoperatively with use of methylene blue injection were corrected by laparoscopic ligation (two) or postoperative angioembolization (one). Postoperative pump radionuclide flow studies confirmed isolated hepatic artery infusion in all cases. There was a 13% pump-related complication rate. During a median follow-up of 11 months (0.5 to 35.5 months), the actuarial rate of overall survival was 47% and the estimated median survival time was 17.5 months. CONCLUSIONS LHAIP placement is technically feasible, and variant HA is not associated with increased pump complications or decreased pump functional time.
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Affiliation(s)
- Jun Cheng
- General Surgery, TC-29260, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
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de Wilt JHW, van Etten B, Verhoef C, Eggermont AMM. Isolated hepatic perfusion: experimental evidence and clinical utility. Surg Clin North Am 2004; 84:627-41. [PMID: 15062665 DOI: 10.1016/s0039-6109(03)00233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many patients with tumors confined to the liver are not amenable for surgical resection, and an increasing number of these patients are treated by local ablation methods. Isolated hepatic perfusion is another treatment option especially suitable for patients with multiple or bulky primary or metastatic tumors. and can mediate clinical regression of advanced liver metastases. Experience with IHP is still limited to a few centers in the world because of its technical difficulties, surgery-related morbidity, and unproven efficacy. IHP remains an experimental modality restricted to specialized units dedicated to treating this difficult group of patients. Experimental animal IHP models have led us to explore new ways of improving efficacy, reducing technical difficulties, and minimizing regional and systemic toxicity. Future research should be directed to the identification of suitable biological or chemotherapeutic agents, defining clinical indications, and development of technical modifications to make it more generally applicable.
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Affiliation(s)
- Johannes H W de Wilt
- Erasmus MC (University Medical Center Rotterdam)-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
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Abstract
Hepatic metastases are a frequent complication of colorectal cancer (CRC), affecting over half of all CRC patients. Resection of isolated metastases can result in long-term survival, but the majority of patients relapse, and most have unresectable disease. Hepatic arterial infusion (HAI) chemotherapy delivers high concentrations of cytotoxic agents directly to liver metastases with minimal systemic toxicities. Advances in surgical techniques, development of fully implantable pumps, and modification of drug regimens have decreased complications and improved patient tolerability. Randomized trials comparing HAI with systemic chemotherapy have demonstrated superior response rates and times to hepatic progression for unresectable disease, and have shown better times to progression and overall survival rates in the adjuvant setting following hepatic resection. HAI chemotherapy has unique toxicities, including chemical hepatitis and biliary sclerosis, which can be mitigated by the addition of dexamethasone to therapy. In an attempt to prevent extrahepatic progression, combinations of HAI with systemic chemotherapy, including newer agents such as irinotecan and oxaliplatin, are currently being investigated, with promising early results.
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Affiliation(s)
- Adam D Cohen
- Gastrointestinal Oncology Service, Solid Tumor Division, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Barber FD, Fabugais-Nazario LE. What's old is new again: patients receiving hepatic arterial infusion chemotherapy. Clin J Oncol Nurs 2004; 7:647-52. [PMID: 14705480 DOI: 10.1188/03.cjon.647-652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. Although uncommon in North America, the incidence of HCC in the United States has increased by 70% since the 1980s (Yu, Yuan, Govindarajan, & Ross, 2000). The most frequent causes of malignant hepatic disease in the United States are metastases from melanoma and primary tumors of the gastrointestinal tract, breast, and lung. Surgical resection and systemic chemotherapy are the standard treatments for this disease. However, surgery is not an option for patients with advanced disease, and the response rate from systemic chemotherapy remains low. An alternative therapy for patients with HCC or cancers with liver metastases is hepatic arterial infusion of chemotherapy directly into the liver. This method allows a high total body clearance and hepatic extraction to generate high hepatic and low systemic exposures. Nursing care of patients receiving hepatic arterial infusion of chemotherapy includes patient education and monitoring for complications.
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Tono T, Kanoh T, Ohnishi T, Matsushita M, Nakano Y, Kimura Y, Iwazawa T, Yano H, Okamura J, Monden T. Adjuvant hepatic arterial infusion after curative resection of colorectal liver metastases using removable intra-arterial catheters with shape-memory alloy. J Surg Oncol 2004; 88:248-55. [PMID: 15565591 DOI: 10.1002/jso.20159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Although there are some reports that adjuvant hepatic arterial infusion (HAI) chemotherapy reduces the hepatic recurrence following curative resection of colorectal liver metastases, problems of indwelling catheters after chemotherapy cessation remains unsolved. The usefulness of adjuvant HAI was investigated using a removable port-catheter system. METHODS Spiral catheterstrade mark were attempted to be placed in 17 patients who underwent curative hepatectomy. The catheter contains a special shape-memory alloy at its tip, which allows stable fixation to the vascular wall without coiling so the catheter can be removed if necessary. 5-fluorouracil (5-FU) in total dose of 12 g was intra-arterially administered. RESULTS W spiral catheterstrade mark were successfully placed in the hepatic artery by percutaneous approach in 82% of the patients. All patients underwent scheduled chemotherapy without serious adverse events. Reservoir-catheter system was removed easily and uneventfully after discontinuation of the chemotherapy. 3D-CT angiography revealed that the hepatic artery was well preserved with short-term chemotherapy. Postoperative hepatic recurrence was observed only in 18% of the patients with the median follow-up time of 19.9 months. CONCLUSIONS Prophylactic 5-FU HAI using W spiral cathetertrade mark and subsequent catheter extirpation is a promising strategy following curative resection of colorectal liver metastases.
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Affiliation(s)
- Takeshi Tono
- Department of Surgery, NTT West Osaka Hospital, Tennoji-ku, Osaka, Osaka, Japan.
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Gaffney EA. The application of mathematical modelling to aspects of adjuvant chemotherapy scheduling. J Math Biol 2003; 48:375-422. [PMID: 15052504 DOI: 10.1007/s00285-003-0246-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2003] [Revised: 08/21/2003] [Indexed: 10/26/2022]
Abstract
In this paper simple models for tumour growth incorporating age-structured cell cycle dynamics are considered in the presence of two non-cross-resistant S-phase specific chemotherapeutic drugs. According to the seminal work of Goldie and Coldman, if one cannot deliver two cell cycle phase non-specific, non-cross-resistant drugs simultaneously, for example due to toxicity, and both drugs are identical apart from resistance, one should alternate their delivery as rapidly as possible. However consider S-phase specific drugs. One might speculate that, for example, alternating the two drugs at intervals of T, where T is the mean cell cycle time, is better than alternating the drugs at intervals of T/2, as the latter strategy allows the possibility of a cell cycle sanctuary. Such speculation implicitly requires a sufficiently low variance of the cell cycle time, and hence it is not clear if such reasoning prevents a generalisation of the results of Goldie and Coldman. This question is addressed in this paper via a detailed modelling investigation, as motivated by suggestions for future colorectal adjuvant chemotherapy trials and developments in hepatic arterial infusion technology. It is shown that the cell cycle distribution of the resistant cell populations is strongly influenced by the chemotherapy schedule. The consequences of this can be dramatic, and can lead to chemotherapy failure at resonant chemotherapy timings, especially for a small standard deviation of the cell cycle time. The novel aspects of this observation are highlighted compared to other models in the literature exhibiting resonant behaviour in the timing of a periodic chemotherapy protocol. The above investigation also results in the principal prediction of this paper that reducing the drug alternation time to approximately a few hours, if possible, can result in substantial improvements in predicted chemotherapy outcomes. Critically, such improvements are not predicted by the Goldie Coldman model or other chemotherapy scheduling models in the literature.
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Affiliation(s)
- E A Gaffney
- The school of Mathematics and Statistics, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Zhang ZY, Zhang WY, Qian SC. Hepatic artery infusion of adriamycin combined with hemoperfusion in dogs. Shijie Huaren Xiaohua Zazhi 2003; 11:1160-1163. [DOI: 10.11569/wcjd.v11.i8.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To observe the concentration of circulating ADM and its side effects by hepatic artery infusion of Adriamycin(ADM) combined with hemoperfusion (HP).
METHODS ADM was infused through the dogs hepatic artery. At the same time, the femoral artery and femoral vein catheters were inserted and HP(NK-107 resin (HPI) and Japanese activated charcoal(HP II) as adsorbents) was performed. The concentration of circulating blood ADM was determined and blood routine, myocardiac enzymes, liver and kidney function were observed.
RESULTS The plasma concentration of ADM at 1 h, 2 h; 3 d and 14 d in HP I, II groups (89±9, 60±15, 21±5, 10±2; 99±14, 61±13, 26±5, 12±2 mg.l-1) were decreased apparently as compared with the control group (312±23, 237±12, 116±15, 58±8 mg.l-1) (P<0.01). After HP 24 h (0.9±0.4, 11.9±6.4, 1.0±0.3; 1.1±0.3, 4.3±3.7, 1.9±0.6 μkat.l-1) and 72 h (0.9±0.4, 8.2±4.5, 0.8±0.3; 1.1±0.1, 2.6±2.3, 2.7±2.3 μkat.l-1), myocardiac enzymes (LDH, CPK-MB, α-HBDH) had no change (P>0.05). But in control group, after HP 24 h (1.6±0.2, 23.9±12.9, 2.7±0.3 μkat.l-1), they began to increase (P<0.05) and increased markedly after 72 h (3.1±0.1, 33.7±10.4, 8.5±0.3 μkat.l-1) (P<0.01) as compared with before HP (0.8±0.1, 11.1±10.7, 1.4±0.1 μkat.l-1). Before and after HP, the peripheral WBC, RBC, Hb and Pt at 3, 7 and 14 d had no significant change (P >0.05). But in the control group WBC, Pt, RBC and Hb were lower than before (16.3±4.2×109/L, 131±38×109/L, 5.9±1.6×1012/L, 131±28 g/L) at 7 d (8.5±5.4×109/L, 77±35×109/L, 4.8±1.2×1012/L, 94±27 g/L) (P<0.05) and much lower than before at 14 d (6.2±4.4×109/L, 69±39×109/L, 5.2±1.6×1012/L, 109±28 g/L P<0.01). Before and after HP, no obvious changes were found in liver function (ALT, AST and TBil) and kidney function (BUN and Cr) (P>0.05).
CONCLUSION ADM hepatic artery infusion combined with HP, using NK-107 resin and Japanese activated charcoal as adsorbents, can decrease the concentration of circulating blood ADM and its side effects.
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Affiliation(s)
- Zhi-You Zhang
- Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China
| | - Wen-Yi Zhang
- Department of Pharmacology, Tianjin Medical University, Tianjin 300070, China
| | - Shao-Chen Qian
- Department of Gastroenterology, Tianjin Third Central Hospital, Tianjin 300170, China
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Abstract
AIM: To evaluate the role of preoperative angiography in the diagnosis and treatment of colorectal cancer.
METHODS: The authors performed selective arterial cannulation by Seldinger's method in 47 patients to locate the primary cancer and to diagnose metastasis to the liver. Each patient was then given intra-arterial regional chemotherapy, and received 5-fluorouracil (5-Fu, 1000 mg), mitomycin C (MMC, 20 mg), and cisplatinum (CDDP, 80 mg).
RESULTS: The location and shape of each tumor were observed, including metastatic tumors in the liver, in 42 of the 47 (89.4%) patients. The site of the primary tumor was difficult to identify in 5 cases because the patients had a recurrence of cancer. Arterial chemotherapy was performed successfully in all patients. The authors recorded no partial or significant morbidity resulted from angiography. The only incident was bleeding from the artery puncture site in one patient, which was successfully stopped by general medication.
CONCLUSION: Preoperative selective arterial angiography can help the diagnosis and locate primary tumors and to detect liver metastasis. At the same time, regional arterial chemotherapy can be an important form of preoperative therapy.
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Affiliation(s)
- Jin Gu
- Department of Surgery, Oncology School of Peking University, 52 FuCheng Road, Beijing 100036, China.
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Abstract
The liver is the commonest site of distant metastasis of colorectal cancer and nearly half of the patients with colorectal cancer ultimately develop liver involved during the course of their diseases. Surgery is the only therapy that offers the possibility of cure for patients with hepatic metastatic diseases. Five-year survival rates after resection of all detectable liver metastases can be up to 40%. Unfortunately, only 25% of patients with colorectal liver metastases are candidates for liver resection, while the others are not amenable to surgical resection. Regional therapies such as radiofrequency ablation and cryotherapy may be offered to patients with isolated unresectable metastases but no extrahepatic diseases. Hepatic artery catheter chemotherapy and chemoembolization and portal vein embolization are often used for the patients with extensive liver metastases but without extrahepatic diseases, which are not suitable for regional ablation. For the patients with metastatic colorectal cancer beyond the liver, systemic chemotherapy is a more appropriate choice. Immunotherapy is also a good option when other therapies are used in combination to enhance the efficacy. Selective internal radiation therapy is a new radiation method which can be used in patients given other routine therapies without effects.
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Affiliation(s)
- Lian-Xin Liu
- Department of Surgery, First Clinical College, Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin 150001, Heilongjiang Province, China.
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Liu LX, Zhang WH, Jiang HC, Zhu AL, Wu LF, Qi SY, Piao DX. Arterial chemotherapy of 5-fluorouracil and mitomycin C in the treatment of liver metastases of colorectal cancer. World J Gastroenterol 2002; 8:663-7. [PMID: 12174375 PMCID: PMC4656317 DOI: 10.3748/wjg.v8.i4.663] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Regional chemotherapy using hepatic artery catheters is a good method of treating patients with colorectal cancer liver metastases. We investigated the survival of patients with liver metastases from colorectal cancer using 5-fluorouracil (5-FU) and mitomycin C Cthrough implantable hepatic arterial infusion port.
METHODS: Seventy-five patients with inoperable liver metastases from colorectal cancer were included between March, 1992 and November, 2001. We placed implantable hepatic arterial catheter (HAC) port by laparotomy.5-FU, 1000 mg/m2/d continuous infusion for five days every four weeks, was delivered in the hepatic arterial catheter through the port. Mitomycin C, 30 mg/m2/d infusion in the first day every cycle through the port. Response to the treatment was evaluated by serial determinations of plasma CEA and imaging techniques consisting of computerized tomography and sonography of liver.
RESULTS: Sixty-eight were performed hepatic artery chemotherapy and fifty-six were followed up among seventy-five HAC patients. Twenty-six patients (46.4%) have responded and 4 complete remission were achieved. Eight patients (14.3%) had stable liver metastases. Twenty-two patients (39.3%) were progressed with increased tumor size and number. Twenty-nine patients (51.8%) had a decreased serum CEA level, while 10 patients (17.9%) were stable and 17 patients (30.4%) had an increased serum CEA level. There were no operative death in this series. Complications, which occurred in 18 patients (32.1%), were as followed: hepatic artery thrombosis in 11, Upper gastric and intestinal bleeding in 3, liver abscess in 1, pocket infection in 1, cholangitis in 1, and hepatic artery pseudo-aneurysm in one patient.
CONCLUSION: Combined infusion of 5-FU and mitomycin C by hepatic artery catheter port is an effective treatment for liver metastases from colorectal cancer. The high response and lower complication rates prove the adjuvant treatment of colorectal cancer with this treatment.
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Affiliation(s)
- Lian-Xin Liu
- Department of Surgery, the First Clinical College, Harbin Medical University, No.23 Youzheng Street, Nangang District, Harbin 150001, Heilongjiang Province, China.
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