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Ueshima K, Komemushi A, Aramaki T, Iwamoto H, Obi S, Sato Y, Tanaka T, Matsueda K, Moriguchi M, Saito H, Sone M, Yamagami T, Inaba Y, Kudo M, Arai Y. Clinical Practice Guidelines for Hepatic Arterial Infusion Chemotherapy with a Port System Proposed by the Japanese Society of Interventional Radiology and Japanese Society of Implantable Port Assisted Treatment. Liver Cancer 2022; 11:407-425. [PMID: 36158592 PMCID: PMC9485983 DOI: 10.1159/000524893] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 04/04/2022] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular carcinoma is one of the leading causes of cancer-related death both in Japan and globally. In the advanced stage, hepatic arterial infusion chemotherapy (HAIC) is one of the most commonly used treatment options for liver cancer in Japan, and implantation of a catheter system (called a port system) in the body is a treatment method that has evolved mainly in Japan. The Guideline Committee of the Japanese Society of Interventional Radiology and the Japanese Society of Implantable Port Assisted Treatment jointly published clinical practice guidelines for HAIC with a port system to ensure its appropriate and safe performance in Japanese in 2018. We have written an updated English version of the guidelines with the aim of making this treatment widely known to experts globally. In this article, the evidence, method, indication, treatment regimen, and maintenance of the system are summarized.
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Affiliation(s)
- Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Iwamoto
- Division of Gastroenterology/Iwamoto Internal Medicine Clinic, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Shuntaro Obi
- Department of Internal Medicine, Teikyo University Chiba General Medical Center, Chiba, Japan
| | - Yozo Sato
- Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Toshihiro Tanaka
- Department of Radiology/IVR Center, Nara Medical University, Nara, Japan
| | - Kiyoshi Matsueda
- Department of Diagnostic Ultrasound & Interventional Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Michihisa Moriguchi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Hiroya Saito
- Imaging and IVR Center, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Arai Y, Aoyama T, Inaba Y, Okabe H, Ihaya T, Kichikawa K, Ohashi Y, Sakamoto J, Oba K, Saji S. Phase II study on hepatic arterial infusion chemotherapy using percutaneous catheter placement techniques for liver metastases from colorectal cancer (JFMC28 study). Asia Pac J Clin Oncol 2015; 11:41-8. [PMID: 25628061 DOI: 10.1111/ajco.12324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
AIM This prospective multicenter study aimed to evaluate the efficacy and adverse events of hepatic arterial infusion chemotherapy (HAIC) using percutaneous catheter placement techniques for liver metastases from colorectal cancer (CRC). METHODS We administered 5-fluorouracil at 1000 mg/m2 over 5 h via hepatic arterial infusion on a weekly schedule. The primary endpoint was the overall response rate (RR). The secondary endpoints were the overall survival (OS), progression-free survival (PFS) and toxicities. RESULTS Between February 2000 and March 2002, seventy-seven eligible patients were enrolled in this study. After a median of 26 treatment cycles, 4 patients achieved a complete response, 29 achieved a partial response, 28 had stable disease, 15 had progressive disease and the status of one patient was unknown. The overall RR was 42.9% and the disease control rate (DCR) was 79.2%. The median PFS and OS times were 203 and 560 days, respectively. The most common grade 3 or 4 hematological and non-hematological toxicities were total bilirubin level elevation (10.4%) and gamma-glutamyl transferase level elevation (10.4%). With regard to the relationship between the background factors and treatment outcomes, the DCR, RR, PFS and OS were different between patients with and without extrahepatic lesions (DCR: 86.5% vs 64%, RR: 46.2% vs 36.0%, PFS: 233 days vs 99 days, OS: 587 days vs 558 days). CONCLUSION The primary endpoint of this study was not met. HAIC using percutaneous catheter placement techniques did not improve the RR for liver metastasis from CRC.
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Affiliation(s)
- Yasuaki Arai
- National Cancer Center, Central Hospital, Tokyo, Japan
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Seki H, Ozaki T, Ooi H. Dual-phase CT angiography through the port-catheter system for hepatic arterial infusion chemotherapy using multislice CT: assessment of system dysfunction and impact on predicting clinical problems. Acta Radiol 2012; 53:1026-34. [PMID: 22940859 DOI: 10.1258/ar.2012.120174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hepatic arterial infusion (HAI) chemotherapy is being explored for treatment of malignant liver tumors. Maintenance of HAI systems is important for effective treatment. PURPOSE To prospectively evaluate the efficacy of dual-phase CT angiography through the port-catheter system for HAI chemotherapy. MATERIAL AND METHODS This study enrolled 47 patients receiving HAI chemotherapy for malignant liver tumors who underwent dual-phase CT angiography through the port-catheter system using multislice CT. Using maximum intensity projection images reconstructed from vascular-phase CT imaging, hepatic arterial patency and catheter location were assessed. Using a combination of vascular- and perfusion-phase CT imaging, system dysfunction and clinical problems were evaluated. RESULTS Dual-phase CT angiography was conducted 156 times. Stenosis and obstruction of the hepatic artery and catheter dislodgment were observed seven times in four patients and four times in three patients, respectively. Diagnostic accuracy using vascular-phase CT imaging was 100%. In addition, development of collateral blood supply to the liver and extrahepatic perfusion to the stomach were observed three times in three patients and twice in two patients, respectively. Overall, system dysfunction occurred 16 times in 12 patients, and system correction and treatment modification were required 11 times in 10 patients. In assessing system dysfunction and predicting clinical problems, the accuracy of dual-phase CT imaging was 100%. CONCLUSION Dual-phase CT angiography through the port-catheter system is helpful for assessing catheter system dysfunction and predicting clinical problems in HAI chemotherapy.
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Affiliation(s)
- Hiroshi Seki
- Department of Diagnostic Radiology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toshirou Ozaki
- Department of Diagnostic Radiology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroyuki Ooi
- Department of Diagnostic Radiology, Niigata Cancer Center Hospital, Niigata, Japan
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Phase I/II Study of Radiologic Hepatic Arterial Infusion of Fluorouracil Plus Systemic Irinotecan for Unresectable Hepatic Metastases from Colorectal Cancer: Japan Clinical Oncology Group Trial 0208-DI. J Vasc Interv Radiol 2012; 23:1261-7. [DOI: 10.1016/j.jvir.2012.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022] Open
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Safety and Optimal Management of Hepatic Arterial Infusion Chemotherapy After Pancreatectomy for Pancreatobiliary Cancer. AJR Am J Roentgenol 2012; 198:923-30. [DOI: 10.2214/ajr.11.6751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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6
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Guiu B, Vincent J, Guiu S, Ladoire S, Ortega-Deballon P, Cercueil JP, Chauffert B, Ghiringhelli F. Hepatic arterial infusion of gemcitabine-oxaliplatin in a large metastasis from colon cancer. World J Gastroenterol 2010; 16:1150-4. [PMID: 20205288 PMCID: PMC2835794 DOI: 10.3748/wjg.v16.i9.1150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic arterial infusion (HAI) of chemotherapy can be performed in cases of liver-confined metastatic disease, resulting in increased local drug concentrations. Here we report the case of a 61-year-old man who presented with an isolated large unresectable liver metastasis of colon cancer after failure of surgery and multiple administration of systemic chemotherapy. The patient was treated with a combination of gemcitabine and oxaliplatin using HAI. The tolerance was excellent and a radiological complete response was obtained after 8 cycles of HAI. The rationale for the use of gemcitabine and oxaliplatin as well as that for the combination of the 2 drugs is discussed in this paper. HAI of gemcitabine-oxaliplatin should be evaluated in further clinical trials.
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Deriving the Intrahepatic Arteriovenous Shunt Rate from CT Images and Biochemical Data Instead of from Arterial Perfusion Scintigraphy in Hepatic Arterial Infusion Chemotherapy. Cardiovasc Intervent Radiol 2009; 32:946-51. [DOI: 10.1007/s00270-009-9603-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 04/04/2009] [Accepted: 05/01/2009] [Indexed: 11/27/2022]
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Superselective intra-arterial chemotherapy for advanced maxillary sinus cancer: an evaluation of arterial perfusion with computed tomographic arteriography and of tumor response. J Comput Assist Tomogr 2008; 32:397-402. [PMID: 18520544 DOI: 10.1097/rct.0b013e3181151331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of our study was to elucidate the relationship between arterial perfusion in advanced maxillary sinus cancer which was opacified by superselective intra-arterial computed tomographic arteriography (IA-CTA) and the tumor response to intra-arterial chemotherapy. METHODS Superselective IA-CTA was performed to identify the feeding arteries and their perfusion in advanced maxillary sinus cancer in 10 patients. Cisplatin was selectively infused into these feeding arteries, except for the internal carotid artery. RESULTS The results were assessed in 9 of the 10 patients, and a complete response was achieved in 5 patients in whom either the entire tumor, or most of the tumor, was perfused by the branches of the external carotid artery. In 4 patients with a partial response, the residual tumors were seen in the territory of the perfusion defect or in the perfusion territory of the internal carotid artery. CONCLUSION Superselective IA-CTA is a useful technique to correctly identify the intratumoral perfusion and to predict tumor response to the intra-arterial chemotherapy of advanced maxillary sinus cancer.
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Arai Y, Takeuchi Y, Inaba Y, Yamaura H, Sato Y, Aramaki T, Matsueda K, Seki H. Percutaneous catheter placement for hepatic arterial infusion chemotherapy. Tech Vasc Interv Radiol 2008; 10:30-7. [PMID: 17980316 DOI: 10.1053/j.tvir.2007.08.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatic arterial infusion chemotherapy employs a hepatic artery catheter as a conduit to achieve a high concentration of antineoplastic agents to liver tumors. Historically, this catheter placement has been performed via laparotomy. However, it may now be performed using less-invasive percutaneous image guided procedures. There are many anatomical hepatic arterial variations and complicated blood flow patterns. Various techniques are required to ensure high concentration of antineoplastic agents in liver tumors. These techniques are composed of arterial redistribution by embolization, percutaneous catheter placement applying "tip-fixation method," and evaluation and management of flow patterns that reflect drug distribution. The role of interventional radiologists in hepatic arterial infusion chemotherapy is to create and manage the access to achieve these objectives.
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Affiliation(s)
- Yasuaki Arai
- Division of Diagnostic Radiology, National Cancer Center, Tokyo, Japan.
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10
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Ikeda O, Tamura Y, Nakasone Y, Shiraishi S, Kawanaka K, Tomiguchi S, Yamashita Y, Takamori H, Kanemitsu K, Baba H. Comparison of intrahepatic and pancreatic perfusion on fusion images using a combined SPECT/CT system and assessment of efficacy of combined continuous arterial infusion and systemic chemotherapy in advanced pancreatic carcinoma. Cardiovasc Intervent Radiol 2007; 30:912-21. [PMID: 17710478 DOI: 10.1007/s00270-007-9134-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 05/04/2007] [Accepted: 05/14/2007] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to compare intrahepatic and pancreatic perfusion on fusion images using a combined single-photon emission computed tomography (SPECT)/CT system and to evaluate the efficacy of combined continuous transcatheter arterial infusion (CTAI) and systemic chemotherapy in the treatment of advanced pancreatic carcinoma. MATERIALS AND METHODS CTAI was performed in 33 patients (22 men, 11 women; age range, 35-77 years; mean age, 60 years) with stage IV pancreatic cancer with liver metastasis. The reservoir was transcutaneously implanted with the help of angiography. The systemic administration of gemcitabine was combined with the infusion of 5-fluorouracil via the reservoir. In all patients we obtained fusion images using a combined SPECT/CT system. Pancreatic perfusion on fusion images was classified as perfusion presence or as perfusion absent in the pancreatic cancer. Using WHO criteria we recorded the tumor response after 3 months on multislice helical CT scans. Treatment effects were evaluated based on the pancreatic cancer, liver metastasis, and factors such as intrahepatic and pancreatic perfusion on fusion images. For statistical analysis we used the chi-square test; survival was evaluated by the Kaplan Meier method (log-rank test). RESULTS On fusion images, pancreatic and intrahepatic perfusion was recorded as hot spot and as homogeneous distribution, respectively, in 18 patients (55%) and as cold spot and heterogeneous distribution, respectively, in 15 (45%). Patients with hot spot in the pancreatic tumor and homogeneous distribution in the liver manifested better treatment results (p < 0.05 and p < 0.01, respectively). Patients with hot spot both in the pancreatic cancer and in the liver survived longer than those with cold spot in the pancreatic cancer and heterogeneous distribution in the liver (median +/- SD, 16.0 +/- 3.7 vs. 8.0 +/- 1.4 months; p < 0.05). CONCLUSIONS We conclude that in patients with advanced pancreatic cancer, CTAI with systemic chemotherapy appeared to be effective and may prolong their survival. The development of a reservoir port system allowing for the homogeneous distribution of anticancer drugs is necessary to improve the prognosis of patients with advanced pancreatic cancer.
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MESH Headings
- Adenocarcinoma/blood supply
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/mortality
- Adenocarcinoma/secondary
- Adenocarcinoma/therapy
- Adult
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carcinoma, Pancreatic Ductal/blood supply
- Carcinoma, Pancreatic Ductal/diagnostic imaging
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Catheters, Indwelling
- Chemoembolization, Therapeutic/methods
- Deoxycytidine/administration & dosage
- Deoxycytidine/analogs & derivatives
- Equipment Design
- Female
- Fluorouracil/administration & dosage
- Humans
- Infusions, Intra-Arterial
- Injections, Intravenous
- Kaplan-Meier Estimate
- Liver Circulation
- Liver Neoplasms/blood supply
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/mortality
- Liver Neoplasms/secondary
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Pancreatic Neoplasms/blood supply
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Prospective Studies
- Regional Blood Flow
- Time Factors
- Tomography, Emission-Computed, Single-Photon/methods
- Tomography, Spiral Computed/methods
- Treatment Outcome
- Gemcitabine
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Affiliation(s)
- Osama Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8556, Japan.
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11
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Sameshima S, Horikoshi H, Motegi K, Tomozawa S, Hirayama I, Saito T, Sawada T. Outcomes of hepatic artery infusion therapy for hepatic metastases from colorectal carcinoma after radiological placement of infusion catheters. Eur J Surg Oncol 2007; 33:741-5. [PMID: 17399936 DOI: 10.1016/j.ejso.2007.02.012] [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] [Received: 11/16/2006] [Accepted: 02/12/2007] [Indexed: 10/23/2022] Open
Abstract
AIM The aim of this study is to evaluate the safety and efficacy of hepatic artery infusion (HAI) of 5-fluorouracil (5FU) for patients with liver metastases from colorectal carcinoma after radiological placement of infusion catheters. METHODS Forty-two patients with liver metastases from colorectal carcinoma received radiological placement of infusion catheters using the distal fixation method. They received continuous HAI of 5FU 1,000-1,500mg for 5h weekly or biweekly. Tumor status was assessed by chest-abdominal computed tomography (CT) scan after every 10 infusions. Hepatic perfusion was checked by CT arteriography via the infusion port after every 10 infusions. RESULTS Radiological placements of catheters were performed successfully in all cases. Each patient received an average of 36 treatments (range: 10-98). Catheter failure was found in 3 patients (7.1%). Nine incidents of grade 1 toxicity were observed in 8 patients (19.0%). There was a complete response in 6 patients, partial remission in 18, stable disease in 9, and progression of disease in 9 (response rate: 57.1%). Overall median survival time was 29.1 months. Using Cox's proportional hazard model, lymph node metastases in primary colorectal carcinoma and pre-treatment serum CEA affected overall survival (P=0.011, P=0.005). CONCLUSIONS HAI after radiological placement of infusion catheters is a safe and effective treatment particularly for patients with no lymph node metastasis in primary carcinoma or with a low pre-treatment serum CEA level.
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MESH Headings
- Aged
- Angiography
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Biomarkers, Tumor/blood
- Carcinoembryonic Antigen/blood
- Carcinoma/drug therapy
- Carcinoma/secondary
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Catheters, Indwelling/adverse effects
- Chemotherapy, Cancer, Regional Perfusion/instrumentation
- Colonic Neoplasms/pathology
- Disease Progression
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Fluorouracil/therapeutic use
- Hepatic Artery
- Humans
- Infusion Pumps
- Liver Neoplasms/drug therapy
- Liver Neoplasms/secondary
- Male
- Radiography, Interventional
- Rectal Neoplasms/pathology
- Remission Induction
- Survival Rate
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- S Sameshima
- Department of Surgery, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Gunma 373-8550, Japan.
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12
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Schillaci O, Filippi L, Danieli R, Simonetti G. Single-Photon Emission Computed Tomography/Computed Tomography in Abdominal Diseases. Semin Nucl Med 2007; 37:48-61. [PMID: 17161039 DOI: 10.1053/j.semnuclmed.2006.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Single-photon emission computed tomography (SPECT) studies of the abdominal region are established in conventional nuclear medicine because of their easy and large availability, even in the most peripheral hospitals. It is well known that SPECT imaging demonstrates function, rather than anatomy. It is useful in the diagnosis of various disorders because of its ability to detect changes caused by disease before identifiable anatomic correlates and clinical manifestations exist. However, SPECT data frequently need anatomic landmarks to precisely depict the site of a focus of abnormal tracer uptake and the structures containing normal activity; the fusion with morphological studies can furnish an anatomical map to scintigraphic findings. In the past, software-based fusion of independently performed SPECT and CT or magnetic resonance images have been demonstrated to be time consuming and not useful for routine clinical employment. The recent development of dual-modality integrated imaging systems, which provide SPECT and CT images in the same scanning session, with the acquired images co-registered by means of the hardware, has created a new scenario. The first data have been mainly reported in oncology patients and indicate that SPECT/CT is very useful because it is able to provide further information of clinical value in several cases. In SPECT studies of abdominal diseases, hybrid SPECT/CT can play a role in the differential diagnosis of hepatic hemangiomas located near vascular structures, in precisely detecting and localizing active splenic tissue caused by splenosis in splenectomy patients, in providing important information for therapy optimization in patients submitted to hepatic arterial perfusion scintigraphy, in accurately identifying the involved bowel segments in patients with inflammatory bowel diseases, and in correctly localizing the bleeding sites in patients with gastrointestinal bleeding.
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Affiliation(s)
- Orazio Schillaci
- Department of Biopathology and Diagnostic Imaging, University "Tor Vergata," Rome, Italy.
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Seki H, Shiina M. Placement of a long tapered side-hole catheter in the hepatic artery: technical advantages, catheter stability, and arterial patency. AJR Am J Roentgenol 2006; 187:1312-20. [PMID: 17056922 DOI: 10.2214/ajr.05.0741] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the technical advantages, safety, and efficacy of placing a catheter distally in the hepatic artery using a long tapered side-hole catheter with an implantable port for hepatic arterial infusion chemotherapy. SUBJECTS AND METHODS Fifty patients with unresectable malignant liver tumors underwent radiologic implantation of catheter-port systems using the long tapered catheter placement method. A 2.7-French distal shaft of the catheter was inserted distally in the hepatic artery with its side hole located proximally, and a 5-French proximal shaft was placed in the aorta; the catheter tip was not fixed. Technical success, complications including catheter stability and hepatic artery patency, and tumor response were assessed and compared with the following two historical controls: 35 patients with a 5-French catheter inserted simply in the hepatic artery (conventional method), and 131 patients with a 5-French catheter, the tip of which was fixed in the gastroduodenal artery (the fixed-catheter-tip method). RESULTS The technical success rate using the long tapered catheter placement method was 92% (46/50 patients), whereas the feasibility of the fixed-catheter-tip method was confined to 79% of historical controls (131/166 patients). Among patients in whom the gastroduodenal artery was present, a decreased frequency of gastroduodenal artery embolization was seen using the long tapered catheter placement method (39%; 17/44 patients) compared with the conventional method (p = 0.0112) and the fixed-catheter-tip method (p < 0.0001). Cumulative stability rates of the catheter (6 months, 94.9%; 1 year, 94.9%; 2 years, 86.2%) and cumulative patency rates of the hepatic artery (6 months, 89.9%; 1 year, 89.9%; 2 years, 83.5%) were significantly higher using the long tapered catheter placement method than using the conventional method (p = 0.0208 and p = 0.0066, respectively) but were similar to those using the fixed-catheter-tip method. The time of hepatic tumor progression was significantly longer using the long tapered catheter placement method than using the conventional method (p = 0.0299) but was comparable to the time using the fixed-catheter-tip method. CONCLUSION The long tapered catheter placement method should find wider application in hepatic arterial infusion chemotherapy because it is useful in preventing catheter dislodgment and hepatic artery occlusion.
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Affiliation(s)
- Hiroshi Seki
- Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Kawagishi-cho, Niigata 951-8566, Japan.
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14
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Ikeda O, Kusunoki S, Nakaura T, Shiraishi S, Kawanaka K, Tomiguchi S, Yamashita Y, Takamori H, Chikamoto A, Kanemitsu K. Comparison of Fusion Imaging Using a Combined SPECT/CT System and Intra-arterial CT: Assessment of Drug Distribution by an Implantable Port System in Patients Undergoing Hepatic Arterial Infusion Chemotherapy. Cardiovasc Intervent Radiol 2006; 29:371-9. [PMID: 16502168 DOI: 10.1007/s00270-005-0268-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinoma of the liver. We compared the perfusion patterns of HAI chemotherapy on intra-arterial port-catheter computed tomography (iapc-CT) and fused images obtained with a combined single-photon emission computed tomography/computed tomography (SPECT/CT) system. We studied 28 patients with primary or metastatic carcinoma of the liver who bore an implantable HAI port system. All underwent abdominal SPECT using Tc-99m-MAA (185 Mbq); the injection rate was 1 mL/min, identical to the chemotherapy infusion rate, and 0.5 mL/sec for iapc-CT. Delivery was through an implantable port. We compared the intrahepatic perfusion (IHP) and extrahepatic perfusion (EHP) patterns of HAI chemotherapy on iapc-CT images and fused images obtained with a combined SPECT/CT system. In 23 of 28 patients (82%), IHP patterns on iapc-CT images and fused images were identical. In 5 of the 28 patients (18%), IHP on fusion images was different from IHP on iapc-CT images. EHP was seen on fused images in 12 of the 28 patients (43%) and on iapc-CT images in 8 patients (29%). In 17 patients (61%), upper gastrointestinal endoscopy revealed gastroduodenal mucosal lesions. EHP was revealed on fused images in 10 of these patients; 9 of them manifested gastroduodenal toxicity at the time of subsequent HAI chemotherapy. Fusion imaging using the combined SPECT/CT system reflects the actual distribution of the infused anticancer agent. This information is valuable not only for monitoring adequate drug distribution but also for avoiding potential extrahepatic complications.
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Affiliation(s)
- Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Honjo Kumamoto, Japan.
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Tanaka T, Sakaguchi H, Anai H, Yamamoto K, Morimoto K, Nishiofuku H, Kichikawa K. Catheter position for adequate intra-arterial chemotherapy for advanced pancreatic cancer: evaluation with CT during arterial injection of contrast material. J Vasc Interv Radiol 2005; 15:1089-97. [PMID: 15466795 DOI: 10.1097/01.rvi.0000131220.07444.7b] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To identify the drug infusion vessel for use in obtaining the best drug distribution in arterial infusion chemotherapy for advanced pancreatic cancer. MATERIALS AND METHODS In 16 cases of advanced pancreatic cancer (pancreatic head, n = 12; pancreatic body and/or tail, n = 4), computed tomography during arterial injection of contrast material was performed at the time of angiography. The sites of catheter placement were celiac artery, superior mesenteric artery, and their branches, such as gastroduodenal artery, inferior pancreatico-duodenal artery, or dorsal pancreatic artery. RESULTS In the cases of pancreatic head cancer, all except one with hepatomesenteric vascular variation were supplied by the celiac artery and superior mesenteric artery (dual supply). In the cases of pancreatic body and/or tail cancer, two were supplied by celiac artery alone and two showed dual supply. In the cases of pancreatic head cancer, when the areas supplied by the main trunk were compared with those supplied by its branches, three of nine cases on the celiac artery side and four cases on the superior mesenteric artery side showed that the areas were not consistent, with a partial defect observed in the areas supplied by branches of the superior mesenteric artery. In the cases of pancreatic body and/or tail cancer, on both sides, one of two cases was not consistent. CONCLUSIONS To achieve optimal drug distribution in arterial infusion chemotherapy for advanced pancreatic cancer, drug infusion via both the celiac artery and superior mesenteric artery is required in the majority of cases. In many cases, optimal drug distribution is not attainable with drug infusion via a branch; therefore, drug infusion should be administered via the main trunk.
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Affiliation(s)
- Toshihiro Tanaka
- Department of Radiology, Nara Medical University, 840 Shijo-cho Kashihara, 634 to 8522, Japan.
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Seki H, Ozaki T, Takaki S, Ooi H, Oda J, Shiina M. Using slow-infusion MR arteriography and an implantable port system to assess drug distribution at hepatic arterial infusion chemotherapy. AJR Am J Roentgenol 2003; 180:681-6. [PMID: 12591674 DOI: 10.2214/ajr.180.3.1800681] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess perfusion patterns seen on slow-infusion MR arteriography using the hepatic arterial infusion system compared with those seen on CT arteriography. SUBJECTS AND METHODS In 37 patients with liver metastases who had implantable port systems for hepatic arterial infusion chemotherapy, slow-infusion MR arteriography using an infusion rate of 10 mL/hr through an implantable port and CT arteriography using an injection rate of 0.7 mL/sec were performed. In 15 of 37 patients, we evaluated enhancement patterns of tumors of the liver and visceral organs using slow-infusion MR arteriography. In all 37 patients, we compared slow-infusion MR arteriography with CT arteriography concerning intra- and extrahepatic perfusion patterns. RESULTS On slow-infusion MR arteriography performed 10-20 min after initiation of infusion, tumors of the liver revealed significant enhancement with only a slight effect of systemic enhancement. In seven (19%) of 37 patients, intrahepatic distributions on slow-infusion MR arteriography differed from those on CT arteriography. In eight patients, the patterns of extrahepatic perfusion into the duodenum and the pancreas head differed on slow-infusion MR arteriography from those seen on CT arteriography. In addition, strong artifact caused by platinum coils in the gastroduodenal artery interfered with the evaluation of perfusion in the area around the coils on CT arteriography, whereas no imaging artifact was seen on slow-infusion MR arteriography. CONCLUSION We believe that slow-infusion MR arteriography reflects the actual distribution of infused drugs more accurately than CT arteriography. When clinical complications occur during treatment, slow-infusion MR arteriography should be used to assess perfusion abnormalities.
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Affiliation(s)
- Hiroshi Seki
- Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Kawagishi-cho, Niigata 951-8566, Japan
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Sone M, Kato K, Nakasato T, Ehara S. Multislice CT angiography through an implantable catheter and port system: early experience in detection of vascular complications during hepatic arterial infusion chemotherapy. J Comput Assist Tomogr 2002; 26:515-9. [PMID: 12218811 DOI: 10.1097/00004728-200207000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of multislice CT in the evaluation of vascular patency in patients during hepatic arterial infusion chemotherapy of liver tumors. MATERIALS AND METHODS Thirty-three patients were prospectively examined by CT angiography through the indwelling catheter and port system. Visibility of hepatic arteries and vascular patency were graded 0 to 3 and were compared with digital subtraction angiography (DSA). RESULTS Average visualization scores of CT angiography and DSA were 1.7 and 2.5, respectively, in common hepatic artery (CHA) and proper hepatic artery (PHA), 2.5 and 2.3 in right hepatic artery (RHA), 2.6 and 2.6 in left hepatic artery (LHA), 2.3 and 2.2 in segmental RHA, and 2.1 and 2.0 in segmental LHA. Stenoses were found in proximal hepatic arteries in 9 on CT angiography and 13 on DSA. Stenoses were found in branches of the hepatic artery in 21 on CT angiography and 16 on DSA. CONCLUSION The authors' results indicate that multislice CT angiography of the hepatic arteries is equivalent to DSA and may demonstrate vascular complications of hepatic arterial infusion chemotherapy.
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Affiliation(s)
- Miyuki Sone
- Department of Radiology, Iwate Prefectural Kitakami Hospital, Kitakami, Japan.
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18
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Hashimoto M, Heianna J, Tate E, Kurosawa R, Nishii T, Mayama I. The feasibility of retrograde catheterization of the right gastric artery via the left gastric artery. J Vasc Interv Radiol 2001; 12:1103-6. [PMID: 11535775 DOI: 10.1016/s1051-0443(07)61599-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Retrograde catheterization of the right gastric artery was attempted in 22 patients for the purpose of proximal right gastric artery embolization. Retrograde catheterization was successfully performed in 12 of the 14 patients (86%) with smooth anastomoses. Retrograde catheterization was unsuccessful (n = 1) or time-consuming (n = 1) in two patients (14%) with smooth anastomoses. Right gastric artery embolization was successfully performed with microcoils in 13 of the patients. In all eight patients with tortuous anastomoses, catheterization was unsuccessful. Retrograde catheterization should be considered possible when preliminary angiography indicates a smooth anastomosis with the left gastric artery.
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Affiliation(s)
- M Hashimoto
- Department of Radiology, Akita University School of Medicine, 1-1-1 Hondo, Akita City, Akita 010-0041, Japan.
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Seki H, Ozaki T, Takano T, Takaki S, Yoshimura N, Kimura M, Sakai K. MR arteriography using an implantable port system: a new method in assessing perfusion abnormalities during hepatic arterial infusion chemotherapy. J Comput Assist Tomogr 2000; 24:890-2. [PMID: 11105707 DOI: 10.1097/00004728-200011000-00013] [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: 11/26/2022]
Abstract
We present a case in which MR arteriography (MRA) with an indwelling catheter was used in a perfusion study of intrahepatic arterial chemotherapy for liver metastases. After embolization of collateral vessels using platinum coils, CT imaging was disturbed by strong artifact. However, platinum coils produced no MR artifact. In addition, MRA had greater advantages in depicting perfusion defects than perfusion scintigraphy. We consider MRA useful in assessing perfusion abnormalities during intrahepatic arterial chemotherapy.
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Affiliation(s)
- H Seki
- Department of Radiology, Niigata University School of Medicine, Asahimachi-dori, Japan.
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20
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Seki H, Kimura M, Yoshimura N, Yamamoto S, Ozaki T, Sakai K. Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: assessment of factors affecting patency of the hepatic artery. Clin Radiol 1999; 54:221-7. [PMID: 10210340 DOI: 10.1016/s0009-9260(99)91155-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously. PATIENTS AND METHODS Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed. RESULTS Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE. CONCLUSION We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.
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Affiliation(s)
- H Seki
- Department of Radiology, Niigata University School of Medicine, Japan
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Sakai T, Inagaki R, Taniguchi T, Shinozuka K, Kunitomo M, Hayashi N, Ishii Y, Muramatsu I. Persistent release of noradrenaline caused by anticancer drug 4'-epidoxorubicin in rat tail artery in vitro. Eur J Pharmacol 1998; 356:25-30. [PMID: 9761420 DOI: 10.1016/s0014-2999(98)00505-6] [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: 11/15/2022]
Abstract
Anthracycline derivatives including 4'-epidoxorubicin are known to cause cardiovascular side effects. In this study we examined the effects of 4'-epidoxorubicin on sympathetic nerves of rat tail artery in vitro. Treatment with 4'-epidoxorubicin at concentrations higher than 10 microM gradually increased the resting tension of the arterial strips, an effect which was greatly enhanced by subsequent addition of 10 microM cocaine. This increase of the resting tension by 4'-epidoxorubicin was prevented by prazosin, suppressed in the arterial strips of reserpine-pretreated rats, and reduced by superoxide dismutase. However, tetrodotoxin and histamine receptor antagonists (diphenhydramine and cimetidine) failed to influence it. The contractile response to electrical sympathetic stimulation was slightly attenuated by 30 microM 4'-epidoxorubicin. 4'-epidoxorubicin did not shift the concentration-response curve for noradrenaline. In the superfusion experiments, the basal release of noradrenaline was increased approximately five-fold by 30 microM 4'-epidoxorubicin, and this increase was not inhibited by 0.1 microM prazosin, 0.5 microM tetrodotoxin, 10 microM cocaine or Ca2+-free medium. Noradrenaline release evoked by electrical stimulation was gradually suppressed by 30 microM 4'-epidoxorubicin treatment. These results suggest that 4'-epidoxorubicin directly acts on the sympathetic nerve to cause persistent release of noradrenaline in rat tail artery.
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Affiliation(s)
- T Sakai
- Department of Radiology, School of Medicine, Fukui Medical University, Japan
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