PubMed · 8539358
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D L Miller. 1996. First, do no harm.. https://doi.org/10.1148/radiology.198.1.8539358
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PURPOSE: Percutaneous ethanol injection therapy (PEIT) with a 2-10 ml ethanol dose per session is widely used in the treatment of small hepatocellular carcinoma. Larger doses have been restricted for fear of complications. The aim of the present study was to make a retrospective evaluation of the complications following treatment of hepatic tumors with high doses of ethanol (up to 200 ml). MATERIAL AND METHODS: The medical records of 15 patients treated repeatedly with PEIT were reviewed retrospectively to detect side effects or complications. Eleven of these patients had undergone transarterial chemoembolization (TAE) prior to PEIT. Of 173 ethanol injections in doses of 2-200 ml (mean 49 ml), more than 10 ml had been injected on 138 occasions. The chi-square test was used to evaluate the differences in pain frequency among the various dosage groups. RESULTS: Serious complications did not occur. Pain was a common side effect, occurring in 48% of the procedures. Immediate pain during the treatment was related to the ethanol dose and increased significantly with increasing doses (p < 0.01). Other side effects were rare. CONCLUSION: PEIT with doses higher than previously reported seems to be safe. This should encourage further clinical studies that aim at fully working out the clinical value of such treatment.
Embolizing chemotherapeutic methods are presently used primarily for nonresectable metastatic hepatic carcinoma. Because this kind of carcinoma is generally ischemic, little is expected from embolizing chemotherapeutic methods aimed at tumor necrosis by blood flow obstruction using gelatin sponges. On the other hand, since the arrival rate of Lipiodol is not very good, embolizing chemotherapeutic therapy employing Lipiodol is not expected to be very effective. Consequently, therapies against metastatic hepatic carcinoma have mainly been intraarterial chemotherapies without embolization. Spherex is a transient embolization agent prepared by suspending 60 mg/ml of degradable starch microspheres (hereinafter, DSM) in physiological saline. It was developed by Pharmacia AB, Sweden, as an arterial embolizing agent for embolizing chemotherapy, and it was the first agent approved for use in Japan as an embolization material. DSM is composed of spherical particles approx. 45 microns in diameter prepared by crosslinking partially hydrolyzed potato starch using epichlorohydrin as a crosslinking agent, and it is characterized by gradual decomposition by blood amylase, having a half-life of 20-35 minutes in vitro. Clinically, when Spherex is administered via the arteries, embolization has been found to occur in the arterioles. Furthermore, administration of Spherex via the hepatic artery in combination with an anticancer drug results in the formation of transient reduction of bloodflow, thus making it possible to extend the period of retention of the anticancer drug at a high concentration in the tumorous region. As a result, the local antitumor effect of the anticancer drug may be reinforced, with alleviation of systemic side effects. In clinical tests involving its administration to metastatic hepatic tumors in combination with mitomycin C (hereinafter, MMC), the efficacy is 54.5% with arterial injection therapy with Spherex, which is significantly superior to the 20.0% obtained with arterial injection of MMC alone. Although the rate of side effects exhibited, including pain, digestive symptoms and fever, has been significantly higher in combination with Spherex, myelosuppression indicated by abnormal fluctuations in leukocyte and platelet counts was found to be greater with administration of MMC alone, suggesting its value as an effective future therapy for metastatic hepatic carcinoma. These data indicate that Spherex is not expected to yield an antitumor effect due to long-term blood flow obstruction in the hepatic artery, an effect associated with gelatin sponges heretofore used for embolizing chemotherapy. Instead, it causes a transient occlusion upon one-shot intraarterial injection therapy with MMC, thus extending the retention time of MMC at high concentration in tumorous sections, thereby yielding a high local antitumor effect with MMC.(ABSTRACT TRUNCATED AT 400 WORDS)
Analysis of 37 patients treated with neoadjuvant chemotherapy + radical cystectomy and bilateral lymphadenectomy. Follow-up of patients was until death and survival is between 43 and 68 months. There has been 26 deaths. Of these, 20 occurred within 24 months of therapy and only 6 after a two-year period. Five did not undergo surgery due to accelerated tumour progression during cytostatics administration. In another 5 cases, the idea of removing the bladder was discarded after significant loco-regional progression had been confirmed by laparotomy. 54% had involved lymph nodes. Metastasis was found in 57.3% and local relapse in 17.3%. The pre- operative chemotherapy investigated has not contributed to prolong the disease-free interval in the group of patients studied. After extended follow-up, the chemotherapy-treated group fared worse as compared with cystectomy alone and irradiation therapy (4,500 and 2,000 Rads.) followed by cystectomy. Presently, no patient should be deprived of the most effective therapy available: Surgery. Surgery should be a key step for the treatment of vesical infiltrant cancer. There are no resistant subpopulations to this option. Another question is to argue what sort of surgery should be used: TUR, radical o partial cystectomy. The ¿T¿ is useless to assess the efficacy of any therapeutical option adjuvant to surgery. Patients with pT2, pT3a tumours should be excluded from protocols designed to evaluate the performance of therapies added to surgery. All protocols investigating and adjuvant approach to radical cystectomy should include a control group with surgery alone.