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Ishitani K, Isoai A, Ito T, Sugiyama H, Arakawa A, Yamada Y, Onodera H, Kobayashi R, Torii N, Soneda N, Matsuno Y, Utsugisawa T, Kato M, Hanafusa N. Clinical usefulness of cell-free and concentrated ascites reinfusion therapy (CART) in combination with chemotherapy for malignant ascites: a post-marketing surveillance study. Int J Clin Oncol 2021; 26:1130-1138. [PMID: 33761026 DOI: 10.1007/s10147-021-01883-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cell-free and concentrated ascites reinfusion therapy (CART) has been suggested to be able to treat malignant ascites more safely and effectively with chemotherapy because of its ability to retain serum protein and albumin. Although the characteristics of cancer types and CART and the clinical implications of combination therapy with antitumor agents are becoming widespread, there are limited reports on its efficacy and complications. METHODS In this prospective observational national post-marketing study, 128 patients with malignancies received 300 CART sessions at 22 centers. After excluding other malignancies, the patients were divided into four groups: gynecological malignancies with chemotherapy (GYC+; 18 cases and 36 times) and without chemotherapy (GYC-; 35 cases and 52 times), and gastrointestinal malignancies with chemotherapy (GIC+; 8 cases and 16 times) and without chemotherapy (20 cases and 58 times). RESULTS There were significant reductions in the body weight in all groups and significant reductions in abdominal circumference and significant improvements in the diet and Eastern Cooperative Oncology Group performance status only in the GYC+ group. The total serum protein and albumin increased significantly in all groups, except for the GIC+ group, before and after CART. There was no significant difference in the presence or absence of antitumor medication. CONCLUSION With CART, there were differences in the improvement of the clinical symptoms between malignancy groups. The combination of CART and antineoplastic agents may be as safe as CART alone in cases of exudative malignant ascites.
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Affiliation(s)
- Ken Ishitani
- Department of Gynecology, Kitasato University Kitasato Institute Hospital, 5-9-1, Shirokane, Minato-ku, Tokyo, 108-8642, Japan. .,Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ayako Isoai
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroshi Sugiyama
- Department of Gastroenterology, Kizawa Memorial Hospital, Gifu, Japan
| | - Atsushi Arakawa
- Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yosuke Yamada
- Division of Nephrology, Shinshu University Hospital, Nagano, Japan
| | - Hirokazu Onodera
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Ryosuke Kobayashi
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Naoko Torii
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Noriko Soneda
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Yoshihiro Matsuno
- Blood Purification Division, Asahi Kasei Medical Co., Ltd, Tokyo, Japan
| | - Taiju Utsugisawa
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University, Tokyo, Japan
| | - Michio Kato
- Kato Michio Clinic of Liver Diseases, Hyogo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
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Yamamoto K, Nagao S, Tsu T, Matsushima T, Ishido Y, Narita M, Suzuki K, Nakazawa H, Shibutani T, Jimi T, Yano H, Kitai M, Shiozaki T, Matsuoka K, Yamaguchi S. Quality of life assessment of cell-free and concentrated ascites reinfusion therapy during initial treatment for advanced ovarian cancer: A prospective cohort study. J Obstet Gynaecol Res 2021; 47:1536-1543. [PMID: 33469981 DOI: 10.1111/jog.14670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/22/2020] [Accepted: 01/03/2021] [Indexed: 11/27/2022]
Abstract
AIM Cell-free and concentrated ascites reinfusion therapy (CART) is applied to relieve symptoms in patients with malignant ascites. We performed a prospective cohort study to evaluate the efficacy and safety of CART performed on patients with advanced ovarian and peritoneal cancers with massive ascites during the initial treatment. METHODS From April 2018 to July 2020, CART was performed during the initial treatment of 31 patients with advanced ovarian and peritoneal cancers with cancerous ascites. Patient characteristics and clinical information before and after CART were collected. We performed quality of life assessment using the Japanese version of the M.D. Anderson Symptom Inventory (MDASI-J) 24 h before and after CART. RESULTS CART was performed 38 times in 24 patients before or during neoadjuvant chemotherapy and 11 times in 11 patients prior to surgery. Four patients underwent CART before primary surgery and before and/or during chemotherapy. Grade 1-2 fever was observed in 18 of 31 cases (58%), and all were controllable by nonsteroidal anti-inflammatory drugs. CART did not adversely affect the main treatment, chemotherapy, or surgery. CART significantly improved the MDASI-J symptom and interference scores within 24 h after the procedure. The symptom and interference scores decreased from 2.4 to 1.8 and from 4.8 to 3.0, respectively. CONCLUSIONS CART can be safely performed and is useful for symptom relief and improvement of general condition prior to initial surgery and during initial chemotherapy in ovarian and peritoneal cancers. Performing CART at the time of initial treatment may facilitate initiation of the main treatment.
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Affiliation(s)
- Kasumi Yamamoto
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Shoji Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Tomoharu Tsu
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Taeko Matsushima
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Yoshimi Ishido
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Moyu Narita
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kazuhiro Suzuki
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Hiroshi Nakazawa
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Takashi Shibutani
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Tomoatsu Jimi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Hiroko Yano
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Miho Kitai
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Takaya Shiozaki
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kazuko Matsuoka
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Japan
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Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in refractory ascites: Post-marketing surveillance results. PLoS One 2017; 12:e0177303. [PMID: 28510606 PMCID: PMC5433707 DOI: 10.1371/journal.pone.0177303] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/25/2017] [Indexed: 12/19/2022] Open
Abstract
We performed post-marketing surveillance to evaluate the safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART). In total, 356 CART sessions in 147 patients at 22 centers were performed. The most common primary disease was cancer (128 cases, 300 sessions). Mean amount of ascites collected was 3.7 L, and mean concentration ratio was 9.2. Mean amount of reinfused protein was 67.8 g (recovery rate, 72.0%). Performance status, dietary intake, urine volume, body weight and abdominal circumference were significantly improved after CART. Body temperature increased significantly, by 0.3°C on average. Concomitant steroids and/or NSAIDs use before reinfusion was significantly and negatively associated with increases in body temperature. Most adverse events were fever and chills. This study examined a large number of patients compared with previous studies, and showed that CART is an effective and relatively safe treatment for refractory ascites, such as malignant ascites.
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Akimaru K, Ueda Y, Shoji T. Peritoneovenous shunting for intractable cirrhotic and cancerous ascites using different types of shunting tubes. THE JAPANESE JOURNAL OF SURGERY 1988; 18:502-8. [PMID: 3230724 DOI: 10.1007/bf02471482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A total of twenty six peritoneovenous shuntings were performed in our department between 1978 and 1984, on twelve cirrhotic and ten cancerous patients with intractable ascites, using Pudenz, LeVeen or Denver type shunting tubes. Reduced ascites was noted postoperatively with statistical significance in both the cirrhotic group (p less than 0.05) and the cancerous group (p less than 0.01), of whom eight cirrhotic and seven cancerous patients exhibited an abdominal girth reduced by 9.7 cm (a 10.9 per cent reduction) in two weeks. A larger urinary output was noted in 13 patients, with a mean increase of 587 ml/day compared with the pre-shunting output. These patients lost a mean weight of 6.13 kg in two weeks, while the nonreduced ascites group gained weight. The post-shunting serum albumin level was higher in the reduced ascites group. The mean functioning periods of the shunts were 5.1 and 2 months, respectively for the cirrhotic and cancerous patients whose shunts were patent. The patients' outcome was shown to depend on the disease itself, with the exception of one patient who died of disseminated intravascular coagulopathy following shunting. In comparing several types of shunting systems, the Denver-type was proven as being the most unlikely to plug or malfunction because of its simpler structure.
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Affiliation(s)
- K Akimaru
- Second Department of Surgery, Nippon Medical School, First Hospital, Tokyo, Japan
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Green R. Biochemical aspects of preoperative and postoperative treatment its practical application. Am J Surg 1941. [DOI: 10.1016/s0002-9610(41)90230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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