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Zhang H, Wu C, Chen M, Sun Y, Han J. Drug-eluting bead transarterial chemoembolization (DEB-TACE) versus conventional transarterial chemoembolization (cTACE) in colorectal liver metastasis: Efficacy, safety, and prognostic factors. J Cancer Res Ther 2023; 19:1525-1532. [PMID: 38156918 DOI: 10.4103/jcrt.jcrt_2143_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 09/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To comparatively evaluate drug-eluting bead transarterial chemoembolization (DEB-TACE) and conventional transarterial chemoembolization (cTACE) for efficacy, safety, and related prognostic factors in the treatment of colorectal liver metastasis (CRLM). MATERIALS AND METHODS This study retrospectively analyzed 75 patients with CRLM-administered DEB-TACE (n = 36) or cTACE (n = 39) between January 2016 and December 2017. Local control, survival outcome, and complications were compared between the two groups. Univariate and multivariate analyses of prognostic factors affecting progression-free survival (PFS) and overall survival (OS) were performed. RESULTS The median follow-up in the two groups was 10.5 months (range, 0.5-22). Median PFS and OS in the DEB-TACE group were 10.0 and 13.0 months, respectively, and 6.0 and 8.5 months in the cTACE group, respectively (P = 0.009 and P = 0.008). The 3-, 6-, and 12-month OS rates in the DEB-TACE group were 100.0%, 94.4%, and 55.6%, respectively, and 92.3%, 71.8%, and 35.9% in the cTACE group, respectively. The 3-month OS rate (P = 0.083) showed no significant difference between the two groups, but significant differences were found in the 6- and 12-month OS rates (P = 0.008 and P = 0.030). Univariate and multivariate survival analyses showed that treatment method, tumor size, and tumor number were independent prognostic factors affecting PFS and OS. CONCLUSION DEB-TACE has advantages over cTACE in prolonging PFS and OS in patients with CRLM. Treatment method, tumor number, and tumor size are important prognostic factors affecting PFS and OS. However, further multicenter and prospective trials are needed to confirm a deeper comparison between DEB-TACE and cTACE in patients with CRLM.
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Affiliation(s)
- Hao Zhang
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Chunxue Wu
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Miaoling Chen
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Yuandong Sun
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Jianjun Han
- Interventional Radiology Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
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Irizato M, Nishiofuku H, Sato T, Maeda S, Toyoda S, Matsumoto T, Chanoki Y, Oshima K, Furuichi K, Sueyoshi S, Tanaka T. Transarterial Chemoembolization with Irinotecan-loaded Beads Followed by Arterial Infusion of 5-Fluorouracil for Metastatic Liver Tumors Refractory to Standard Systemic Chemotherapy. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:92-96. [PMID: 37485491 PMCID: PMC10359171 DOI: 10.22575/interventionalradiology.2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/04/2023] [Indexed: 07/25/2023]
Abstract
We report two cases of liver metastases from colorectal and anal cancers after the failure of systemic chemotherapies that were successfully treated with a combination therapy of transarterial chemoembolization using irinotecan-loaded drug-eluting beads and hepatic arterial infusion chemotherapy. In both cases, hepatic arterial infusion chemotherapy was performed as maintenance therapy after irinotecan-loaded drug-eluting beads. Irinotecan at a dose of 120 mg was loaded on drug delivery beads for irinotecan-loaded drug-eluting bead-transarterial chemoembolization. A weekly high-dose 5-fluorouracil regimen (1000 mg/m2/5 h) was used for hepatic arterial infusion chemotherapy. The liver metastases shrank remarkably in both cases, and progression-free survivals of 13 and 9 months, respectively, were obtained without any severe adverse events.
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Affiliation(s)
- Mariko Irizato
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Hideyuki Nishiofuku
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Takeshi Sato
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Shinsaku Maeda
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Shouhei Toyoda
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Takeshi Matsumoto
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Yuto Chanoki
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Keisuke Oshima
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
| | - Kinya Furuichi
- Department of Radiology, Saiseikai Suita Hospital, Japan
| | | | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan
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Dong F, Cao G, Lu Z. HAIC as a potential therapy for esophageal cancer patients with liver metastasis: a retrospective cohort study. Front Med (Lausanne) 2023; 10:1143617. [PMID: 37215706 PMCID: PMC10196257 DOI: 10.3389/fmed.2023.1143617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/27/2023] [Indexed: 05/24/2023] Open
Abstract
Methods This was a single-arm historical cohort study of ESCC patients with synchronous or heterochronous LM between December 2014 and July 2021 at the Department of Gastrointestinal Oncology. The patients were treated with HAIC for LM, and regular image assessments were performed according to the judgment of the interventional physician. Liver progression-free survival (PFS), liver objective response rate (ORR), liver disease control rate (DCR), overall survival (OS), adverse events (AEs), treatment information, and basic characteristics were observed retrospectively. Results Overall, a total of 33 patients were enrolled in this study. All included patients received catheterized HAIC therapy, with a median of three (ranging from 2 to 6) sessions. The treatment response of liver metastatic lesions included partial response (PR) in 16 (48.5%) patients, stable disease (SD) in 15 (45.5%) patients, and progressive disease (PD) in two (6.1%) patients, for an ORR of 48.5% and a DCR of 93.9%. The median liver PFS was 4.8 months (95% confidence interval (CI): 3.0-6.6 months), and the median OS was 6.4 months (95% CI: 6.1-6.6 months). Patients who achieved PR at the liver metastasis site after HAIC were more likely to have a longer OS than those who achieved SD or PD. Grade 3 AEs occurred in 12 patients. The most common grade 3 AE was nausea, occurring in 10 (30.0%) patients, followed by abdominal pain in three (9.1%) patients. Only one patient showed grade 3 elevation of alanine aminotransferase (ALT)/aspartate aminotransferase (AST), and one patient suffered from grade 3 embolism syndrome AEs. Grade 4 adverse events, followed by abdominal pain, occurred in one patient. Conclusion Hepatic arterial infusion chemotherapy might be an option as a regional therapy for ESCC patients with LM, as it is acceptable and tolerable.
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Affiliation(s)
- Fengxiao Dong
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Guang Cao
- Department of Interventional Therapy, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihao Lu
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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Liu P, Zhu H, Zhu H, Zhang X, Feng A, Zhu X, Sun Y. Predicting Survival for Hepatic Arterial Infusion Chemotherapy of Unresectable Colorectal Liver Metastases: Radiomics Analysis of Pretreatment Computed Tomography. J Transl Int Med 2022; 10:56-64. [PMID: 35702189 PMCID: PMC8997799 DOI: 10.2478/jtim-2022-0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Hepatic arterial infusion chemotherapy (HAIC) is an effective treatment for advanced unresectable colorectal cancer liver metastases (CRLM). This study was conducted to predict the efficacy of HAIC in patients with unresectable CRLM by radiomics methods based on pretreatment computed tomography (CT) examinations and clinical data. MATERIALS AND METHODS A total of 63 patients were included in this study (41 in the training group and 22 in the validation group). All these patients underwent CT examination before HAIC. During the follow-up period, CT scans and laboratory examinations were performed regularly. Eighty-five radiological features were extracted from the regions of interest (ROIs) of CT images using the PyRadiomics program. The t-test and correlation were applied to select features. These features were analyzed using LASSO-Cox regression, and a linear model was developed to predict overall survival (OS). RESULTS After reducing features by t-test and correlation test, seven features remained. After LASSO-Cox cross-validation, four features remained at λ = 0.232. They were gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighborhood gray tone difference matrix (NGTDM), and the location of the primary tumor. The C-index was 0.758 in the training group and 0.743 in the test group. Nomograms predicting 1-, 2-, and 3-year survival were established. CONCLUSION Our study demonstrates that a radiomics approach based on pretreatment CT texture analysis has the ability to predict early the outcome of HAIC in patients with advanced unresectable colorectal cancer with a high degree of accuracy and feasibility.
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Affiliation(s)
- Peng Liu
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing100142, China
| | - Haitao Zhu
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
| | - Haibin Zhu
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
| | - Xiaoyan Zhang
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
| | - Aiwei Feng
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing100142, China
| | - Xu Zhu
- Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing100142, China
| | - Yingshi Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing100142, China
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Zheng K, Wang X, Cao G, Xu L, Zhu X, Fu L, Fu S, Cheng H, Yang R. Hepatic Arterial Infusion Chemotherapy with Oxaliplatin and 5-Fluorouracil for Advanced Gallbladder Cancer. Cardiovasc Intervent Radiol 2021; 44:271-280. [PMID: 33078235 DOI: 10.1007/s00270-020-02661-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to assess the safety and efficacy of hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin and 5-fluorouracil for patients with advanced gallbladder cancer (GBC). MATERIALS AND METHODS Twenty-six patients with advanced GBC, who underwent HAIC with oxaliplatin and 5-fluorouracil from January 2012 to July 2019, were enrolled in this retrospective study. The HAIC regimen consisted of infusions of oxaliplatin at 40 mg/m2 for 2 h, followed by 5-fluorouracil at 800 mg/m2 for 22 h on days 1-3 every 3-4 weeks. A maximum of six cycles of HAIC were applied for tumor control patients followed by maintenance with oral capecitabine or S-1. Overall survival (OS), progression-free survival (PFS), tumor response, and adverse events were investigated. RESULTS Six of the 26 patients (23.1%) had failed systemic chemotherapy, 8/26 (30.8%) patients had failed various local therapies, and 9/26 (34.6%) patients had contraindications to systemic chemotherapy. The median OS was 13.5 months, and the median PFS was 10.0 months. The overall response rate was 69.2% (18/26), and disease control rate was 92.3% (24/26). Carcinoembryonic antigen (CEA) ≥ 10 U/ml (p = 0.003) and carbohydrate antigen 19-9 (CA19-9) ≥ 200 U/ml (p = 0.000) were independent risk factors for decreased survival. The most frequent Grade 3 or 4 treatment-related adverse event was liver dysfunction (4, 15.4%). CONCLUSION HAIC with oxaliplatin and 5-fluorouracil is an acceptable and well-tolerated treatment for advanced gallbladder cancer even for patients in whom systemic chemotherapy had failed or is contraindicated. LEVEL OF EVIDENCE Level 2, Observation Study with Dramatic Effect.
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Affiliation(s)
- Kanglian Zheng
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Xiaodong Wang
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China.
| | - Guang Cao
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Liang Xu
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Xu Zhu
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Liqiang Fu
- Department of Biostatistics, School of Public Health, Southern Medical University, 1838 Guangzhou Avenue North, Baiyun District, Guangzhou, China
| | - Shijie Fu
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Haihui Cheng
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
| | - Renjie Yang
- Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, China
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Qingwei Z, Dongsheng H, Duo L, Youlei W, Songxia Y, Ziqi Y, Lanjuan L. Fluorouracil Supplemented With Oxaliplatin or Irinotecan for Solid Tumors: Indications From Clinical Characteristics and Health Outcomes of Patients. Front Oncol 2020; 10:1542. [PMID: 32984012 PMCID: PMC7492525 DOI: 10.3389/fonc.2020.01542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
Fluorouracil combined with oxaliplatin (FOLFOX) and fluorouracil combined with irinotecan (FOLFIRI) are both first-line clinical chemotherapy regimens. However, clinicians' selection of FOLFIRI or FOLFOX medication regimens and their effects on patients' health outcomes are not clear. The aim of this study was to evaluate the impacts on patient characteristics of FOLFIRI or FOLFOX medication regimen selection and the effects of each regimen on patients' health outcomes in a real-world setting. Three thousand seven hundred and twenty-five patients were retrieved and 610 of them were eventually included in this study based on the inclusion and exclusion criteria. The percentages of the TNM stage, cetuximab, bevacizumab, and tumor metastases between the FOLFIRI and FOLFOX groups were different (P < 0.001). In the multivariate Cox proportional hazards model, a significantly higher non-convalescent incidence of the FOLFOX group was found as compared with the FOLFIRI group (HR = 2.211, 95% CI = 1.257–3.888, P = 0.006). In conclusion, the TNM stage, whether combined with cetuximab or bevacizumab, and whether there was tumor metastasis presented as the key factors affecting medication selection between the FOLFIRI and FOLFOX regimens. The FOLFIRI regimen exhibited better effects on patients' long-term health outcomes than did the FOLFOX regimen. This study was registered on the World Health Organization International Clinical Trials Registry Platform (ChiCTR2000029201). Trial registration: ChiCTR2000029201.
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Affiliation(s)
- Zhao Qingwei
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hong Dongsheng
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lv Duo
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wang Youlei
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Songxia
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye Ziqi
- Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Lanjuan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Sato Y, Inaba Y, Aramaki T, Sone M, Morita Y, Nishiofuku H, Tanaka T, Miyazaki M, Matsueda K, Arai Y. Hepatic Arterial Infusion Chemotherapy of 5-Fluorouracil for Patients with Unresectable Liver Metastases from Colorectal Cancer Refractory to Standard Systemic Chemotherapy: A Multicenter Retrospective Study. Oncology 2020; 98:267-272. [PMID: 32092755 DOI: 10.1159/000505520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hepatic arterial infusion chemotherapy (HAIC) is a feasible treatment for patients with colorectal cancer (CRC) with unresectable liver metastases. OBJECTIVE The aim of this retrospective study was to assess HAIC of 5-fluorouracil (5FU) in patients with unresectable liver metastases from CRC refractory to standard systemic chemotherapy. METHODS A total of 137 patients (85 men, 52 women; median age, 62 years; with KRAS mutation, n = 57) were recruited from seven institutions from September 2008 to December 2015. These patients were refractory to systemic chemotherapy including three cytotoxic agents (fluoropyrimidine, oxaliplatin, and irinotecan) with two molecular-targeted agents (bevacizumab and epidermal growth factor receptor antibody [cetuximab or panitumumab]). All patients underwent HAIC of continuous 5FU for unresectable liver metastases. Overall survival time, time to treatment failure, objective response rate, disease control rate, and incidence of adverse events to HAIC were assessed retrospectively. RESULTS The median overall survival time was 4.8 months (95% confidence interval [CI], 4.0-5.7 months), whereas time to treatment failure was 2.4 months (95% CI, 2.0-2.8 months). The objective overall response rate and disease control rate were 12.4 and 64%, respectively. Grade 3 or 4 adverse events were observed in 2.9% of the patients (hyperbilirubinemia in 2, liver abscess in 1, and myelosuppression in 1). CONCLUSIONS There were few incidences of severe adverse events to HAIC of 5FU for liver metastases from CRC refractory to standard systemic chemotherapy. Therefore, it might present as a treatment option as last-line chemotherapy.
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Affiliation(s)
- Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan,
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Morita
- Department of Diagnostic Radiology, Kobe Medical Center, Kobe, Japan
| | | | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Masaya Miyazaki
- Department of Interventional Radiology and Clinical Ultrasound Center, Gunma University Hospital, Maebashi, Japan
| | - Kiyoshi Matsueda
- Diagnostic Imaging Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, Kim TW, Ismail F, Tan IB, Yeh KH, Grothey A, Zhang S, Ahn JB, Mastura MY, Chong D, Chen LT, Kopetz S, Eguchi-Nakajima T, Ebi H, Ohtsu A, Cervantes A, Muro K, Tabernero J, Minami H, Ciardiello F, Douillard JY. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol 2019; 29:44-70. [PMID: 29155929 DOI: 10.1093/annonc/mdx738] [Citation(s) in RCA: 413] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) consensus guidelines for the treatment of patients with metastatic colorectal cancer (mCRC) was published in 2016, identifying both a more strategic approach to the administration of the available systemic therapy choices, and a greater emphasis on the use of ablative techniques, including surgery. At the 2016 ESMO Asia Meeting, in December 2016, it was decided by both ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting, endorsed by both ESMO and JSMO, immediately after the JSMO 2017 Annual Meeting. The aim was to adapt the ESMO consensus guidelines to take into account the ethnic differences relating to the toxicity as well as other aspects of certain systemic treatments in patients of Asian ethnicity. These guidelines represent the consensus opinions reached by experts in the treatment of patients with mCRC identified by the Presidents of the oncological societies of Japan (JSMO), China (Chinese Society of Clinical Oncology), Korea (Korean Association for Clinical Oncology), Malaysia (Malaysian Oncological Society), Singapore (Singapore Society of Oncology) and Taiwan (Taiwan Oncology Society). The voting was based on scientific evidence and was independent of both the current treatment practices and the drug availability and reimbursement situations in the individual participating Asian countries.
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Affiliation(s)
- T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - D Arnold
- CUF Hospitals Cancer Centre, Lisbon, Portugal
| | - H Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - K Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - R-H Xu
- Department of Medical Oncology, Sun Yat-Sen University (SYSU) Cancer Center, Guangzhou, China
| | - T W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - F Ismail
- Department of Radiotherapy & Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - I B Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - A Grothey
- Division of Medical Oncology, Mayo Clinic Cancer Center, Rochester, USA
| | - S Zhang
- Cancer Institute, Zhejiang University, Hangzhou, China
| | - J B Ahn
- Division of Oncology, Department of Internal Medicine, Yonsei Cancer Center, Seoul, Korea
| | - M Y Mastura
- Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - D Chong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - L-T Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - S Kopetz
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Centre, Houston, USA
| | - T Eguchi-Nakajima
- Department of Clinical Oncology, School of Medicine, St. Marianna University, Kanagawa, Japan
| | - H Ebi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - A Ohtsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Cervantes
- CIBERONC, Department of Medical Oncology, Institute of Health Research, INCLIVIA, University of Valencia, Valencia, Spain
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
| | - H Minami
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - F Ciardiello
- Division of Medical Oncology, Seconda Università di Napoli, Naples, Italy
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Fukuoka Y, Tanaka T, Nishiofuku H, Sato T, Masada T, Tatsumoto S, Marugami N, Sakaguchi H, Kichikawa K. Development of Repeatable Microcatheter Access Port for Intra-arterial Therapy of Liver Cancer. Cardiovasc Intervent Radiol 2018; 42:298-303. [PMID: 30390104 DOI: 10.1007/s00270-018-2111-0] [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] [Received: 08/09/2018] [Accepted: 10/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To develop an implantable port in which a microcatheter can be inserted for a combination therapy of repeated transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for advanced liver cancer. MATERIALS AND METHODS The design of a currently used implantable port was modified. A funnel part was constructed in the port. The septum was punctured by a 20-gauge indwelling needle, and 2.0-Fr non-tapered microcatheter was inserted into the port. In the in vitro studies, the advance of a microcatheter out of the funnel part was evaluated via seven different septum puncture sites. A 5-Fr indwelling catheter connected to the port was placed in a vascular model, and a microcatheter catheterization was evaluated. In an in vivo study, the port-catheter system was implanted in the hepatic artery in a pig. A microcatheter was percutaneously inserted through the port into the hepatic arterial branches, and embolization was performed. RESULTS In the in vitro studies, the microcatheter was smoothly advanced out of the port and catheterizations into the hepatic arteries were successful via all septum puncture sites. In the in vivo study, repeated selective embolization through the port was successfully conducted on 7, 14 and 21 days after the implantation. CONCLUSION The developed implantable port can be used for repeated catheter insertion into the hepatic artery. The combination of repeated TACE and HAIC could be possible using this device.
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Affiliation(s)
- Yasushi Fukuoka
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.
| | - Hideyuki Nishiofuku
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Takeshi Sato
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Tetsuya Masada
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Shota Tatsumoto
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Nagaaki Marugami
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | | | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
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He Z, Chen G, Ouyang B, Zhang H, Chen H, Wang Y, Yan S, Pan W. Conformal Radiation Therapy or Stereotactic Body Radiation Therapy: Institutional Experience in the Management of Colorectal Liver Metastases by Radiation Therapy. Technol Cancer Res Treat 2018. [PMCID: PMC6295685 DOI: 10.1177/1533033818816080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Methods: Results: Conclusions:
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Affiliation(s)
- Zemin He
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gang Chen
- Department of Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Ouyang
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haoyue Zhang
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Chen
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yehuang Wang
- National Chinese Medical Center of Colorectal Diseases, The Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Shushan Yan
- Department of Gastrointestinal and Anal Diseases Surgery, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Wei Pan
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Fiorentini G, Carandina R, Sarti D, Nardella M, Zoras O, Guadagni S, Inchingolo R, Nestola M, Felicioli A, Barnes Navarro D, Munos Gomez F, Aliberti C. Polyethylene glycol microspheres loaded with irinotecan for arterially directed embolic therapy of metastatic liver cancer. World J Gastrointest Oncol 2017; 9:379-384. [PMID: 28979720 PMCID: PMC5605338 DOI: 10.4251/wjgo.v9.i9.379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/24/2017] [Accepted: 06/30/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To study tumor response, and tolerability of arterially directed embolic therapy (ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases (CRC-LM). Secondary objectives were to monitor quality of life, time to progression and survival of patients. METHODS Patients were included in the study if they were affected by CRC-LM, refractory to systemic chemotherapy, treated with ADET using polyethylene glycol embolics, and had liver involvement < 50%. Tumor response, performance status (PS), tumor marker antigens, and quality of life (QoL) were monitored at 1, 3 and 6 mo after ADET. QoL was assessed with the Palliative Performance Scale (PPS). RESULTS We treated 50 consecutive CRC-LM patients with ADET using polyethylene glycol embolics. Their tumor response one month after ADET was: 28% of complete response (CR), 48% of partial response (PR), 8% stable disease (SD), and 16% of progression. Tumor response 3 mo after ADET was CR 24%, PR 38%, SD 19% and progression disease (PD) 19%. Tumor response 6 mo after ADET was CR 18%, PR 44%, SD 21% and PD 18%. QoL was 90% PPS at each time point. Median time to progression for patients who progressed was 2.5 mo (range 0.8-6). Median follow-up was 14 mo (0.8-25 range). ADETs were performed with no complications. Observed side effects (mild or moderate intensity) were: Pain in 32% of patients, increase of transaminase levels in 20% and fever in 14%, whereas 30% of patients did not complain any adverse event. CONCLUSION The treatment of unresectable CRC-LM with ADET using polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.
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Affiliation(s)
- Giammaria Fiorentini
- Onco-Hematology Department, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy
| | - Riccardo Carandina
- Oncology Radiodiagnostics Department, Oncology Institute of Veneto, Institute for the Research and Treatment of Cancer, 35128 Padova, Italy
| | - Donatella Sarti
- Onco-Hematology Department, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy
| | - Michele Nardella
- Diagnostic and Interventtional Radiology Department, Ospedale Madonna delle Grazie, 75100 Matera, Italy
| | - Odysseas Zoras
- Surgical Oncology University of Crete, ESSO Board of Directors Member, Rector of the University, Voutes Campus, Heraklion, 71003 Crete, Greece
| | - Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, Section of General Surgery, University of L’Aquila, 67100 L’Aquila, Italy
| | - Riccardo Inchingolo
- Diagnostic and Interventtional Radiology Department, Ospedale Madonna delle Grazie, 75100 Matera, Italy
| | - Massimiliano Nestola
- Diagnostic and Interventtional Radiology Department, Ospedale Madonna delle Grazie, 75100 Matera, Italy
| | - Alessandro Felicioli
- Diagnostic and Interventtional Radiology Department, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy
| | - Daniel Barnes Navarro
- Interventional Radiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | | | - Camillo Aliberti
- Oncology Radiodiagnostics Department, Oncology Institute of Veneto, Institute for the Research and Treatment of Cancer, 35128 Padova, Italy
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Sato Y, Inaba Y, Ura T, Nishiofuku H, Yamaura H, Kato M, Takahari D, Tanaka T, Muro K. Outcomes of a Phase I/II Trial of Hepatic Arterial Infusion of Oxaliplatin Combined with Intravenous 5-Fluorouracil and l-Leucovorin in Patients with Unresectable Liver Metastases from Colorectal Cancer After Systemic Chemotherapy Failure. J Gastrointest Cancer 2017; 49:132-137. [DOI: 10.1007/s12029-016-9915-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Hepatic artery infusion pump (HAIP) use in chemotherapy started in the 1960s as a way to treat liver metastases that were not amendable to locoregional therapy or surgical resection. Because of complications and limited survival benefit, the use of HAIPs fell out of favor. A resurgence has occurred in the use of these pumps, but limited information is available in the literature guiding nursing care of these patients. OBJECTIVES The purpose of this study was to review the literature regarding the use, procedures, and nursing care of patients with HAIPs. METHODS A systematic literature review was conducted to obtain a comprehensive range of publications. FINDINGS Database searching resulted in 511 titles and abstracts. After eliminating duplicates and nonrelevant titles, 65 remained and were read in full. Of these, 20 were excluded because they did not fit the inclusion criteria.
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Affiliation(s)
- Lisa Parks
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus
| | - Meghan Routt
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus
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Zacharias AJ, Jayakrishnan TT, Rajeev R, Rilling WS, Thomas JP, George B, Johnston FM, Gamblin TC, Turaga KK. Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. PLoS One 2015; 10:e0139940. [PMID: 26448327 PMCID: PMC4598149 DOI: 10.1371/journal.pone.0139940] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/19/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data is available on the comparative effectiveness of these options. We hypothesized that outcomes in terms of survival and toxicity were equivalent across the three strategies. METHODS A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013003861) that utilized studies from PubMed (2003-2013). Primary outcome was median overall survival (OS). Secondary outcomes were treatment toxicity, tumor response, and conversion of the tumor to resectable. Additional covariates included prior or concurrent systemic therapy. RESULTS Of 491 studies screened, 90 were selected for analyses-52 (n = 3,000 patients) HAI, 24 (n = 1,268) RE, 14 (n = 1,038) TACE. The median OS (95% CI) for patients receiving HAT in the first-line were RE 29.4 vs. HAI 21.4 vs. TACE 15.2 months (p = 0.97, 0.69 respectively). For patients failing at least one line of prior systemic therapy, the survival outcomes were TACE 21.3 (20.6-22.4) months vs. HAI 13.2 (12.2-14.2) months vs. RE 10.7 (9.5-12.0). Grade 3-4 toxicity for HAT alone was 40% in the HAI group, 19% in the RE group, and 18% in the TACE groups, which was increased with the addition of systemic chemotherapy. Level 1 evidence was available in 5 studies for HAI, 2 studies for RE and 1 for TACE. CONCLUSION HAI, RE, and TACE are equally effective in patients with unresectable CRLM with marginal differences in survival.
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Affiliation(s)
- Anthony J. Zacharias
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Thejus T. Jayakrishnan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - William S. Rilling
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - James P. Thomas
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ben George
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - T. Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kiran K. Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Hepatic arterial infusion plus systemic chemotherapy as third-line or later treatment in colorectal liver metastases. Clin Transl Oncol 2015; 17:870-5. [PMID: 26055340 DOI: 10.1007/s12094-015-1317-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUNDS The present study aimed to evaluate benefit of hepatic arterial infusion chemotherapy (HAI) combined with systemic chemotherapy (SCT) for patients with colorectal liver metastases (CLMs) in a palliative setting. METHODS This was a retrospective single-center study including 43 consecutive patients with CLM after failure of standard SCT. Among them, 20 (47 %) patients underwent HAI combined with SCT (Group A) and 23 historical control patients who had received SCT with or without targeted agent treatment (Group B). RESULTS The two groups had similar characteristics. Compared with SCT alone, HAI combined with SCT prolonged survival (median 19.8 vs. 9.0 months; P = 0.045). Median hepatic progression-free survival was significantly longer for HAI combined with SCT vs. SCT alone (median 8.1 vs. 4.7 months; P = 0.027), as were response rates (25 and 0 %; P = 0.038) and progression-free survival (median 5.7 vs. 3.0 months; P = 0.02). Three patients (15 %) achieved conversion to potentially curative surgery. Grade 3/4 toxicities for Group A and Group B were neutropenia (5 and 8.7 %, respectively), anemia (5 and 0 %, respectively), and hyperbilirubinemia (0 and 4.3 %, respectively). Other complications were mostly grade 1 or 2. CONCLUSIONS HAI combined with SCT treatment can improve overall survival compared with SCT alone in highly advanced CLM refractory to intravenous chemotherapy.
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Side-Hole Catheter Placement with Fixation and Embolization in Common Hepatic Artery for Hepatic Arterial Infusion Chemotherapy (Modified CHA-Coil Method) for Patients with Celiac Artery Stenosis or Occlusion. Cardiovasc Intervent Radiol 2015; 38:1621-6. [PMID: 25828725 DOI: 10.1007/s00270-015-1089-0] [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] [Received: 01/02/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We retrospectively assessed the feasibility of a side-hole catheter placement with fixation and embolization in the common hepatic artery (CHA) (modified CHA-coil method) for hepatic arterial infusion (HAI) chemotherapy. MATERIALS AND METHODS HAI catheter placement was attempted with modified CHA-coil method in five patients with unresectable hepatic malignancies between 2000 and 2013. The reason for using this method, the mode of catheter placement, and the duration of HAI were investigated. RESULTS All patients had either occlusion or stenosis of the celiac artery (CA) or CHA, and, as a result, CHA blood flow had either reversed or decreased and hepatopetal GDA flow was observed. In three patients, the proper hepatic artery was extremely short. The side-hole catheter was inserted through the left subclavian artery and was placed from CA to the right gastroepiploic artery in an anterograde manner (n = 4) and from the superior mesenteric artery to the splenic artery in a retrograde manner through GDA (n = 1). The side hole of the catheter was positioned at the proximal portion of GDA. Using a separate catheter inserted from the right femoral artery, coils were placed around the indwelling catheter of CHA to embolize CHA and to fix the catheter. Coil mislocation was not observed, and catheter placement was successful in all patients. HAI chemotherapy was administered for a median of 136 days. The catheter displacement was not observed during HAI. CONCLUSION The modified CHA-coil method can be used as a stable method for catheter placement when CHA is narrow or there is retrograde CHA blood flow.
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Pharmacokinetics and Antitumor Efficacy of Chemoembolization Using 40 µm Irinotecan-Loaded Microspheres in a Rabbit Liver Tumor Model. J Vasc Interv Radiol 2014; 25:1037-1044.e2. [DOI: 10.1016/j.jvir.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/21/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023] Open
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Nielsen DL, Palshof JA, Larsen FO, Jensen BV, Pfeiffer P. A systematic review of salvage therapy to patients with metastatic colorectal cancer previously treated with fluorouracil, oxaliplatin and irinotecan +/- targeted therapy. Cancer Treat Rev 2014; 40:701-15. [PMID: 24731471 DOI: 10.1016/j.ctrv.2014.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED Oxaliplatin, irinotecan and 5-fluorouracil in combination with or without targeted therapies are well-documented treatment options for first- and second-line treatments of metastatic colorectal cancer. However, there are much less data on the beneficial effect on systemic therapy in the third-line setting. We therefore performed a systematic review of the current literature on third or later lines of treatment to patients with metastatic colorectal cancer after the use of approved drugs or combinations. METHODS A computer-based literature search was carried out using Pubmed and data reported at international meetings. Original studies reporting ≥15 patients who had previously received 5-fluorouracil, oxaliplatin and irinotecan were included. Furthermore, patients with KRAS wild type tumours should had received EGFR-directed therapy. RESULTS Conventional chemotherapeutic agents as capecitabine, mitomycin C, and gemcitabine have limited or no activity. Retreatment with oxaliplatin might be an option in selected patients. In addition, rechallenge with EGFR-directed therapy might be a valuable strategy. Data also suggest that angiogenetic drugs may postpone further progression and prolong survival. Lately, regorafinib has been approved. In conclusion, our current knowledge is based on many retrospective studies, some phase II studies and very few randomized clinical trials. Further prospective phase III trials comparing an investigational drug or combination with best supportive care in third- or later lines of treatment in metastatic colorectal cancer are highly warranted. Identification of predictive biomarkers and improvement of our understanding of molecular mechanisms is crucial.
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Affiliation(s)
| | | | - Finn Ole Larsen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark.
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark.
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Nishiofuku H, Tanaka T, Matsuoka M, Otsuji T, Anai H, Sueyoshi S, Inaba Y, Koyama F, Sho M, Nakajima Y, Kichikawa K. Transcatheter arterial chemoembolization using cisplatin powder mixed with degradable starch microspheres for colorectal liver metastases after FOLFOX failure: results of a phase I/II study. J Vasc Interv Radiol 2012. [PMID: 23194749 DOI: 10.1016/j.jvir.2012.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To report the results of a phase I/II study of a transcatheter arterial chemoembolization protocol using cisplatin powder and degradable starch microspheres (DSM) for unresectable colorectal liver metastases after failure of FOLFOX (5-flourouracil, leucovorin plus oxaliplatin) chemotherapy conducted to determine the recommended dose of cisplatin powder and to assess the efficacy and safety of the protocol. MATERIALS AND METHODS A fine-powder formulation of cisplatin was mixed with DSM and administered via the hepatic artery every 4 weeks. In phase I, three cohorts of patients received escalating doses of cisplatin powder: 50 mg/m(2), 65 mg/m(2), and 80 mg/m(2). In phase II, tumor response, toxicity, and survival times were assessed. RESULTS The study enrolled 24 patients. Previously, FOLFOX had been administered to all patients, an irinotecan-containing regimen had been administered to 12 patients, and bevacizumab or cetuximab or both had been administered to 14 patients. In phase I, dose-limiting toxicity did not appear at any level, and the recommended dose of cisplatin powder was determined to be 80 mg/m(2). In phase II, a tumor response rate of 61.1% was achieved. The median hepatic progression-free survival and overall survival were 8.8 months (95% confidence interval [CI], 4.06-13.5 mo) and 21.1 months (95% CI, 8.37-33.8 mo). The following grade 3 toxicities were observed: thrombocytopenia (12.5%), aspartate transaminase elevation (33.3%), alanine transaminase elevation (12.5%), hyponatremia (8.3%), and cholecystitis (4.2%). CONCLUSIONS This study shows that transcatheter arterial chemoembolization with cisplatin powder at a dose of 80 mg/m(2) mixed with DSM is well tolerated and can produce a high response rate with a long survival time for patients with unresectable colorectal liver metastases after failure of FOLFOX.
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Affiliation(s)
- Hideyuki Nishiofuku
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Nara, Japan.
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Buchler T, Pavlik T, Bortlicek Z, Poprach A, Vyzula R, Abrahamova J, Melichar B. Objective response and time to progression on sequential treatment with sunitinib and sorafenib in metastatic renal cell carcinoma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:81-92. [PMID: 22752573 DOI: 10.5507/bp.2012.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with metastatic renal cell carcinoma (mRCC) are often treated sequentially with targeted agents, although the optimal strategy is not known. A retrospective, registry-based study has been carried out to assess correlation between clinical response and progression-free survival in patients with mRCC treated sequentially with tyrosine-kinase inhibitors (TKIs) sunitinib and sorafenib. Data on 218 mRCC patients treated with sunitinib and sorafenib who completed therapy with both TKIs were obtained from a database of mRCC patients. Standard nonparametric methods were used to assess correlation between response, PFS and length of treatment on the two agents. A strong correlation between responses to first- versus second TKI was observed (p < 0.001). No significant association was noted between the duration of therapy with the two TKIs (p = 0.056), although there was a weak statistically significant correlation between progression-free survival times in the subgroup patients who discontinued treatment because of disease progression. In conclusion, the duration of response on first TKI is of limited value in selecting mRCC patients for sequential TKI therapy. There is a strong correlation between the types of tumour response on the first- versus the second TKI.
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Affiliation(s)
- Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Thomayer Hospital and Charles University, Videnska 800, 140 59, Prague, Czech Republic.
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Unresectable Pancreatic Cancer: Arterial Embolization to Achieve a Single Blood Supply for Intraarterial Infusion of 5-Fluorouracil and Full-Dose IV Gemcitabine. AJR Am J Roentgenol 2012; 198:1445-52. [DOI: 10.2214/ajr.11.8008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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