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At least 163 records · Page 9Linked to original sources
PubMed1990

Intraarterial iododeoxyuridine infusion combined with irradiation. A pilot study.

The halogenated pyrimidine, iododeoxyuridine (IUdR), enhances cytotoxicity of ionizing irradiation experimentally. Continuous intraarterial infusion of IUdR was combined with irradiation to maximize drug concentration in tumor and reduce potential systemic toxicity. Percutaneous tumor-specific artery catheterization was utilized in five patients, with delivery of IUdR (20 mg/kg/day) by continuous infusion 5 days prior to irradiation treatments and continued for 10-14 days. Infusion vessels included the internal mammary, the internal iliac, the renal, the common femoral, and the bronchial arteries. Conventional radiotherapy fields, fractionation, and total doses were utilized, and therapy was well tolerated. Low-grade leukopenia and thrombocytopenia was observed several weeks following infusion. A clinically nonsignificant skin reaction was observed within the irradiation fields 2-3 weeks after initiation of irradiation in several patients. No alopecia or stomatitis was observed. This study minimizes initial hepatic dehalogenation of IUdR when given by intraarterial administration. Two patients have been free of disease for over 20 years, with no long-term toxicity from IUdR therapy.

Adolescent↗
PubMed2002

Assessment of vascularity in hepatic tumors: comparison of power Doppler sonography and intraarterial CO(2)-enhanced sonography.

OBJECTIVE: The purpose of the study was to compare power Doppler sonography with intraarterial CO(2)-enhanced sonography for revealing vascularity in treated and untreated hepatic tumors. SUBJECTS AND METHODS: Fifty-five patients with 93 liver tumors were prospectively examined with power Doppler sonography and CO(2)-enhanced sonography. These tumors included 29 hepatocellular carcinomas in patients with no previous treatment, 26 treated hepatocellular carcinomas, and 38 hemangiomas. The vascular depiction of power Doppler sonography was compared with that obtained in the early phase of CO(2)-enhanced sonography. The results of angiography were also recorded for comparison. RESULTS: In the hepatocellular carcinomas, power Doppler sonography was the same as CO(2)-enhanced sonography in 18 (62%) of 29 tumors, was inferior to CO(2)-enhanced sonography in nine (31%) of 29 tumors, and was superior to CO(2)-enhanced sonography in two (7%) of 29 tumors. In the treated hepatocellular carcinomas, power Doppler sonography was the same as CO(2)-enhanced sonography in 15 (58%) of 26 tumors and was inferior in 11 (42%) of 26 tumors. In hemangiomas, the same vascularity was found in both studies in 15 (39%) of 38 tumors, CO(2)-enhanced sonography was superior in 22 (58%) of 38 tumors, and power Doppler sonography was superior in one (3%) of 38 tumors. As a whole, 45% of the 93 tumors showed better vascular depiction on CO(2)-enhanced sonography. However, 19.4% of tumors were hypovascular using power Doppler sonography but hypervascular using CO(2)-enhanced sonography. CONCLUSION: Power Doppler sonography is a useful technique for screening hepatic tumor vascularity. CO(2)-enhanced sonography is superior to power Doppler sonography in depicting tumor vascularity in treated hepatocellular carcinomas and in hemangiomas, especially small hemangiomas.

Adult↗
PubMed1999

[Cancer of the liver, pancreas, gallbladder, and bile duct].

In cancer of the liver, pancreas, gallbladder, and bile duct, symptoms and signs are non-specific compared with benign conditions. Early detection is difficult and long term survivors are extremely low. The role of systemic chemotherapy in patients with these malignancies is only palliative. Prolongation of survival has not been demonstrated with any single agent or with any combination chemotherapy. However, in some instances, useful symptomatic palliation may occur even without an objective partial response. Quality of life is an important parallel endpoint in these malignancies. In advanced cancer of the liver, numerous alternative therapies have been investigated. These include pharmacologically based chemotherapeutic delivery methods, percutaneous alcohol injection, TAE, TACE, etc. However, further rigorous investigations will be warranted. It is hoped that successful chemotherapeutic agents or other modalities can be developed and combined with limited efficacy of surgery and radiotherapy. In this respect, newer, more active chemotherapy regimens are clearly needed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

[Percutaneous ethanol injection therapy with hepatic arterial infusion chemotherapy for liver metastases from gastric cancer].

Ten patients with liver metastases from advanced gastric cancer received percutaneous ethanol injection therapy (PEI) and chemotherapy by hepatic arterial infusion (HAI) via implantable reservoir. A 90% ethanol solution including 10%. Lipiodol was injected in the liver as PEI.5-FU, EPIR and MMC were used as the regimen for HAI chemotherapy. We have performed this therapy (PEI + HAI) for ten patients with liver metastases since February, 1997. These patients have received this therapy for 4-36 months and three patients died within 16 months. However, three patients did not develop any liver failure after this therapy. The median survival rate was 25.2 months. There are statistically significant differences between upto ss and over se of invasion, and between INF alpha and gamma (p = 0.005).

Aged↗
PubMed1999

[A long-survival case of gastric cancer with multiple liver metastasis: usefulness of intraoperative multimodality therapy and post-operative intra-arterial chemotherapy for liver lesions].

A 62-year-old man was found to have advanced cancer of the gastric cardia with multiple liver metastasis. Total gastrectomy was performed, and 11 hepatic lesions were simultaneously treated by intraoperative multimodality therapy. The therapy included hepatic resections for seven easily-resectable lesions, microwave coagulation therapy for two lesions, and ethanol injection therapy for two. Post-operative intra-arterial infusion of 1,000 mg of 5-FU was performed weekly or every two weeks through the hepatic artery using a reservoir. No recurrence was found during the follow-up period of 35 months. When local control is obtained during surgery in patients with gastric cancer with multiple liver metastasis, intraoperative multimodality therapy and post-operative intra-arterial chemotherapy should be performed for liver lesions.

Adenocarcinoma↗
PubMed2001

[Hepatic infusion of docetaxel using PEIT for a patient with stage IV breast cancer].

Hepatic infusion of docetaxel using PEIT was performed for a patient with stage IV breast cancer. Docetaxel was effective to a solitary liver metastatic lesion. A 64-year-old woman was admitted to our hospital because of a left breast mass that was bleeding. She was diagnosed with stage IV breast cancer. Surgery was performed on February 16th. The pathological diagnosis was invasive ductal carcinoma, and hormone receptors were negative. Two weeks after operation, monthly docetaxel injections were given together with doxifluidine 400 mg/day p.o., cyclophosphamide 50 mg/day p.o., and fadrozole hydrochloride hydrate 2 mg/day p.o. After two courses, hepatic infusion of docetaxel was performed using PEIT after informed consent. The patient's high serum CEA and CA15-3 level returned to the normal range. A metastatic lesion on CT changed to a cystic pattern. These results suggest that PEIT is worth trying in patients with solitary liver metastasis from breast cancer.

Antineoplastic Agents, Phytogenic↗
PubMed1992

A new look in the management of unresectable primary hepatocellular carcinoma.

From January 1992 to October 1992, nine patients with unresectable primary hepatocellular carcinoma were treated either by liver resection combined with transarterial on-target chemotherapy (n = 4) or by transarterial on-target chemotherapy alone (n = 5). All nine patients were seen with diffuse spread of their disease and were considered as refractory to surgical treatment. The patients who had liver resection combined with alcohol transtumoral injection of the residual tumor in the liver remnant and transarterial lipiodol on-target chemotherapy, responded well and were seen postoperatively with a significant decrease in size of their residual tumor, which was found histologically to have advanced necrotic changes. Similarly, the remaining patients, who had only alcohol injection and frequent administration of on-target chemotherapy, were seen with necrosis of their tumor and with decrease in its size. The fetoprotein serum levels were decreased in all patients. None of the patients showed systemic effects from the use of chemotherapy, nor did they demonstrate any hepatotoxic side effects.

Aged↗
PubMed1991

[Improved therapeutic effect of sequential immunotherapy with cyclophosphamide, large doses of OK-432 and recombinant interleukin-2 in breast cancer patients with disseminated metastatic liver tumors].

It has been generally agreed that the prognosis of widely spreaded "surgically unresectable" metastatic liver tumor originated from breast cancer is very poor. We reported here the result of clinical efficacy of sequential immunotherapy with intra-tumoral injection of large dose OK-432, after oral administration of cyclophosphamide during 7-10 days, and continuous perfusion of purified human recombinant interleukin-2 (rIL-2) from hepatic artery for the breast cancer patients with unresectable metastatic liver tumors. In all of 3 cases, metastatic liver tumor revealed overwhelming tumor reduction more than 50% of preoperative total tumor burden evaluated by computed tomography. Only 1 day after operation, large doses of OK-432 was injected intratumorally, both activity of Natural Killer (NK) cells and lymphokine activated killer (LAK) cells in peripheral blood lymphocytes were 5-20 folds augmented in all clinical trials. Serum tumor markers, i.e., Carcinoembryonic Antigen (CEA) and CA15-3, were rapidly decreased in all cases, respectively. Our clinical data indicate that intratumoral injection of large dose OK-432 and continuous administration of rIL-2 via hepatic artery, pretreated with cyclophosphamide, were clinically effective immunotherapy for reduction of metastatic liver tumor.

Administration, Oral↗
PubMed1990

[Warm drug solution injected into tumor vessel may enhance antitumor effect].

A study of hyperthermia was performed after injection of 0.5 mg/kg of MMC into feeding artery of Walker 256 implanted 4 days (early stage) or 8 days (advanced stage) earlier into the s.c. dorsum side of hindpaw of Wistar rats. The tumor growth curves on 6 days after treatment by warming tumor in hot water (44 degrees C) for 60 minutes were inhibited in advanced stage group which formed tumor vessels, but not in the early stage which had not still formed them. An intraarterial injection of warmed 0.01 to 0.05% Noradrenaline solution (44 degrees C, 10 ml) after chemotherapy (0.5 mg/kg of MMC a.i.), by which the temperature did not rise in the tumor tissue but rose to 40 degrees C for 5 to 10 minutes in the tumor vessels, showed severe cytotoxic damage in advanced stage group. The warming target of the tumor for hyperthermia can be considered to be the tumor vessels. Warmed 5% glucose using 0.1 mg of Noradrenaline (500 ml, 44 degrees C) injected into the tumor feeding artery after chemotherapy (2 to 6 mg of MMC or 250 mg of 5-FU a.i.) was tried in advanced cancer patients (liver tumor 4 cases, pancreas tumor 1 case, metastatic bone tumor 1 case, and multicentric tumor in liver, gall bladder and pancreas 3 cases). Efficacy was noted in 8 cases at the rate of 72.7% (8/11). It was concluded that warmed Noradrenaline solution delivered to the tumor vessels after chemotherapy for advanced cancer resulted in good efficacy rate as a from of chemo-thermotherapy.

Animals↗
PubMed1994

[Efficacy of transarterial embolization combined with percutaneous ethanol injection therapy for recurrent hepatocellular carcinoma].

One hundred and eighty-nine patients with hepatocellular carcinoma (HCC) underwent hepatectomy since 1987 to 1992 in our institute. Recurrences were detected on residual liver in 84 patients up to December 1993. Sixty-seven of 84 patients were treated with re-resection (group-O, n = 11), transarterial embolization (TAE) combined with percutaneous ethanol injection therapy (PEIT) (group-TP, n = 13), TAE alone (group-T, n = 34) and intraarterial chemotherapy (group-IA, n = 9). Among these 67 cases, the efficacy of treatment for recurrences was investigated. There was no significant difference in age, positive ratio of hepatitis B virus, ICG R15 and percentage of underlying liver cirrhosis among the 4 groups. However, the frequency of patients with 2 nodules or less, was significantly higher in group-O than in other groups. Cumulative 1-, 2- and 3-year survival rates (%) were 88.9, 64.8 and 51.9 in group-O, 92.1, 55.4 and 55.4 in group-TP, 70.9, 49.6 and 31.0 in group-T, and 16.9, 0 and 0 in group-IA, respectively. The survival rate after recurrences in group-TP was higher than in group-IA and group-T, and almost equivalent to that of group-O. Either re-resection or TAE combined with PEIT might assure- a favorable prognosis in patients with recurrent HCC.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

A new method of intra-arterial regional chemotherapy with more selective drug delivery for locally advanced pancreatic cancer.

BACKGROUND/AIMS: In order to deliver the anti-cancer drugs more selectively into the cancer tissues, we have developed a new method of intra-arterial regional chemotherapy for locally unresectable cancer of the exocrine pancreas. MATERIALS AND METHODS: This method involved placing the catheters selectively into the splenic artery and/or into the gastroduodenal artery during laparotomy. Postoperatively, via the catheter, we infused 50-100 mg of Methotrexate mixed with 10 micrograms of Angiotensin-II with an intent of increasing the blood flow in the tumor tissue but decreasing that to the non-tumor tissues. Simultaneously, a bolus iv-infusion of 5-fluorouracil (5-Fu, 500 mg) was performed. One day after each chemotherapy, citrovorum factor (Leucovorin, 30mg) was given per orally, For 15 patients with locally non-resectable pancreatic cancer, this treatment was repeated weekly or biweekly at our out-patient clinic. RESULTS: As a result, the toxicity was so slight that all patients could tolerate this treatment as long as the catheter was patent (11 +/- 8 postoperative months). The survival period was 16 +/- 9 months (range: 5-36 months; median: 14 months), and one-, two- and three- year survival rates were 60%, 23% and 11%, respectively. Patients could take care of themselves within 12 +/- 9 months, and either complete (50%) or partial (50%) pain-relief was obtained among the 12 patients with severe pain. Only one patient experienced local tumor regression during the chemotherapy, and the incidence of liver metastasis was as low as 13%. CONCLUSIONS: Comparing with the previously reported data in the traditional chemo- and/or radio-therapies, we consider that our method of intra-arterial chemotherapy is quite useful not only for the prolongation of patient's survival but also for improving the quality of life. Thus, this new treatment seems worthy of entering into the prospective randomized study.

Aged↗
PubMed1996

[Role of reservoirs in intraarterial chemotherapy for recurrent hepatocellular carcinoma after hepatectomy].

We conducted a retrospective study on the role of reservoirs in intraarterial chemotherapy for recurrent hepatocellular carcinoma (HCC) after hepatectomy. Ninety-two out of 170 patients with HCC who underwent hepatectomy from 1987 to 1992 in our institute were enrolled in this study. HCC recurred in 55 patients. A rate of good patency of the catheter of the reservoir at the time of recurrence was found in 72.7% of the patients. Transcatheter arterial embolization (TAE) for recurrent tumor was not feasible in 3 patients, because of occlusion of the hepatic artery (3.3% of patients with reservoir, 5.5% of patients with recurrence). Eleven patients were treated by intraarterial chemotherapy using the reservoir and TAE or TAE and PEIT (group R), and 11 patients were treated only with TAE and/or PEIT (group NR). Although there were no significant differences between the two groups in the number of recurrent lesions and operative procedures, tumor-free interval was shorter in group R. Cumulative survival rates after recurrence were not significant. The frequency of TAEs was lower in group R, which shortened the hospitalization for postrecurrence therapy. Thus, intraarterial chemotherapy using reservoir contributed to improvement of the quality of life of patients with recurrent HCC.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Chemoembolization and percutaneous ethanol injection for intrahepatic recurrence of hepatocellular carcinoma after hepatic resection.

BACKGROUND/AIMS: Management of 36 patients who developed intrahepatic recurrence (IHR) after curative hepatic resection for hepatocellular carcinoma (HCC) was studied. MATERIALS AND METHODS: IHRs were classified into type I with a solitary lesion (n = 16), type II with 2-4 lesions (n = 11), and type III with > or = 5 lesions (n = 11). RESULTS: Periodic angiography and Lipiodol CT first detected IHRs in six patients. Most IHRs in type I and II were smaller than 20 mm. Thirty-three patients underwent regional treatments including transarterial infusion of Lipiodol containing anticancer drugs (TAIL) (n = 19), combined TAIL and percutaneous ethanol injection PEI (n = 12), surgery (n = 3), and PEI (n = 1). Post-recurrence 5-yr survival rate of type I (51%) was higher than that of type II (0%) or III (0%) (p < 0.01). Of the 27 patients with type I and II recurrences, seven became tumor-free for 11-67 months after regional treatments including TAIL + PEI (n = 5), TAIL (n = 1), and surgery (n = 1); 13 developed multiple IHRs. CONCLUSIONS: Postoperative close follow-up with qualified imaging and vigorous treatments prolong the survival of the patients with HCC who developed IHRs. Type I or type II IHR can be curable with the combination of TAIL and PEI or repeated surgery.

Adult↗
PubMedDate not supplied

Multidisciplinary management of hepatocellular carcinoma.

BACKGROUND/AIMS: The continuing poor prognosis for patients with hepatocellular carcinoma drives a search for new adjuvant therapies. Targeted locoregional immuno-chemotherapy is one of the most promising. MATERIALS AND METHODS: From 1990 to 1996, 193 patients who were not eligible for liver resection were treated in a prospective randomized study. Ninety-one patients received locoregional targeted chemotherapy only via an arterial catheter (Group A), and 102 received combined locoregional immuno-chemotherapy via two arterial catheters (Group B). RESULTS: Overall survival was significantly different (10.2 months vs 22.3 months), favoring Group B. Complications and side effects of treatment were minimal in Group B and easily handled. Even in Group A, side effects were less severe than effects normally associated with systemic chemotherapy. CONCLUSIONS: Even though the current prognosis for patients with Hepatocellular Carcinoma remains poor, targeted locoregional immuno-chemotherapy has proven to be of benefit in terms of quality of life and survival.

Adult↗