Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy...Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.展开更多
BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stag...BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stage.Existing methods,including palliative gastrectomy,gastrojejunostomy,endoluminal stent,jejunal nutrition tube and intravenous chemotherapy,have limitations in treating these symptoms.AIM To analyze the efficacy of continuous gastric artery infusion chemotherapy(cGAIC)in relieving digestive obstruction in patients with advanced GC.METHODS This study was a retrospective study.Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine.The oxaliplatin-based intra-arterial infusion regimen was applied in all patients.Mild systemic chemotherapy was used in combination with local treatment.The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors(RECIST)criteria.Digestive tract symptoms and toxic effects were analyzed regularly.A comparison of the Karnofsky Performance Status(KPS)score and Stooler’s Dysphagia Score before and after therapy was made.Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.RESULTS All patients finished cGAIC successfully without microcatheter displacement,as confirmed by arteriography.The median follow-up time was 24 mo(95%CI:20.24-27.76 mo).The overall response rate was 89.7%after cGAIC according to the RECIST criteria.The postoperative Stooler’s Dysphagia Score was significantly improved.Twentytwo(75.9%)of the 29 patients experienced relief of digestive obstruction after the first two cycles,and 13(44.8%)initially unresectable patients were then considered radically resectable.The median overall survival time(mOS)was 16 mo(95%CI:9.32-22.68 mo).Patients who received radical surgery had a significantly longer mOS than other patients(P value<0.001).Multivariate Cox regression analysis indicated that radical resection after cGAIC,intravenous chemotherapy after cGAIC,and immunotherapy after cGAIC were independent predictors of mOS.None of the patients stopped treatment because of adverse events.CONCLUSION cGAIC was effective and safe in relieving digestive obstruction in advanced GC,and it could improve surgical conversion possibility and survival time.展开更多
Objective:To analyze the therapeutic effect and influencing factors of arteriovenous combined chemotherapy in 39 patients with advanced gastric cancer,and to explore the choice of therapeutic strategy.Methods:In this ...Objective:To analyze the therapeutic effect and influencing factors of arteriovenous combined chemotherapy in 39 patients with advanced gastric cancer,and to explore the choice of therapeutic strategy.Methods:In this group of patients,the sequence of combined use of arteriovenous chemotherapy was 2 cycles of arterial chemotherapy first,followed by 3~4 cycles of systemic intravenous chemotherapy,and then changed to traditional Chinese medicine,oral chemotherapeutic drugs or immunotherapy after stable disease.Results:Thirty-five patients achieved complete disappearance of symptoms,significant tumor reduction of 26%(PR:13/39),moderate tumor reduction of 51%,18 patients with tumor markers decreased by more than 50%,4 patients completely reduced to normal,half-year survival rate of 90%,1-year survival rate of 56%,3-year survival rate of 33%,5-year survival rate of 10%.Conclusion:The use of arteriovenous combined chemotherapy and embolization in patients with middle and advanced gastric cancer is not only feasible,but also less complications.It can enable some patients to achieve stage II surgical resection,reduce or delay the metastasis and recurrence of patients,improve the quality of life of patients and prolong the survival time.展开更多
Objective: The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy. M...Objective: The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy. Methods: Fifteen cases of endometrial carcinoma were performed intra-arterial chemotherapy and embolization before operation with carboplatin or cisplatin, epirubicin or ADM, and all the cases were performed the arterial chemoembolization with KMG or gel-foam particles mixed with 1/3 total drug dose after 2/3 total drug dose perfusion through the bilateral feeding arteries. Of 15 cases, there were 5 cases with uterine papillary serous carcinoma, 3 cases with endometrial clear cell carcinoma, and 7 cases with endometrial adenosquamous carcinoma. Results: Fifteen cases of endometrial carcinoma were performed operations after 3–4 weeks of intra-arterial chemotherapy and embolization. In these cases, 3 were found mass necrosis and lymphocyte cells infiltration in the tumor tissues but no carcinoma cells, which was noted as histological complete remission (HCR). After intra-arterial chemotherapy and embolization 3–4 weeks, the expression of proliferating cell nuclear antigen (PCNA) was obviously reduced (P < 0.001). Conclusion: The preoperative intra-arterial chemotherapy and embolization can improve the operability of resection in patients with aggressive subtype of endometrial carcinoma, reduce the expression of PCNA, adjust malignancy of endometrial carcinoma, and improve prognosis.展开更多
基金supported by National Natural Science Foundation of China (no. 81471759)Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZYLX202117)。
文摘Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.
基金The study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Zhejiang University School of Medicine(Approval No.I2020001737).
文摘BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stage.Existing methods,including palliative gastrectomy,gastrojejunostomy,endoluminal stent,jejunal nutrition tube and intravenous chemotherapy,have limitations in treating these symptoms.AIM To analyze the efficacy of continuous gastric artery infusion chemotherapy(cGAIC)in relieving digestive obstruction in patients with advanced GC.METHODS This study was a retrospective study.Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine.The oxaliplatin-based intra-arterial infusion regimen was applied in all patients.Mild systemic chemotherapy was used in combination with local treatment.The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors(RECIST)criteria.Digestive tract symptoms and toxic effects were analyzed regularly.A comparison of the Karnofsky Performance Status(KPS)score and Stooler’s Dysphagia Score before and after therapy was made.Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.RESULTS All patients finished cGAIC successfully without microcatheter displacement,as confirmed by arteriography.The median follow-up time was 24 mo(95%CI:20.24-27.76 mo).The overall response rate was 89.7%after cGAIC according to the RECIST criteria.The postoperative Stooler’s Dysphagia Score was significantly improved.Twentytwo(75.9%)of the 29 patients experienced relief of digestive obstruction after the first two cycles,and 13(44.8%)initially unresectable patients were then considered radically resectable.The median overall survival time(mOS)was 16 mo(95%CI:9.32-22.68 mo).Patients who received radical surgery had a significantly longer mOS than other patients(P value<0.001).Multivariate Cox regression analysis indicated that radical resection after cGAIC,intravenous chemotherapy after cGAIC,and immunotherapy after cGAIC were independent predictors of mOS.None of the patients stopped treatment because of adverse events.CONCLUSION cGAIC was effective and safe in relieving digestive obstruction in advanced GC,and it could improve surgical conversion possibility and survival time.
文摘Objective:To analyze the therapeutic effect and influencing factors of arteriovenous combined chemotherapy in 39 patients with advanced gastric cancer,and to explore the choice of therapeutic strategy.Methods:In this group of patients,the sequence of combined use of arteriovenous chemotherapy was 2 cycles of arterial chemotherapy first,followed by 3~4 cycles of systemic intravenous chemotherapy,and then changed to traditional Chinese medicine,oral chemotherapeutic drugs or immunotherapy after stable disease.Results:Thirty-five patients achieved complete disappearance of symptoms,significant tumor reduction of 26%(PR:13/39),moderate tumor reduction of 51%,18 patients with tumor markers decreased by more than 50%,4 patients completely reduced to normal,half-year survival rate of 90%,1-year survival rate of 56%,3-year survival rate of 33%,5-year survival rate of 10%.Conclusion:The use of arteriovenous combined chemotherapy and embolization in patients with middle and advanced gastric cancer is not only feasible,but also less complications.It can enable some patients to achieve stage II surgical resection,reduce or delay the metastasis and recurrence of patients,improve the quality of life of patients and prolong the survival time.
文摘Objective: The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy. Methods: Fifteen cases of endometrial carcinoma were performed intra-arterial chemotherapy and embolization before operation with carboplatin or cisplatin, epirubicin or ADM, and all the cases were performed the arterial chemoembolization with KMG or gel-foam particles mixed with 1/3 total drug dose after 2/3 total drug dose perfusion through the bilateral feeding arteries. Of 15 cases, there were 5 cases with uterine papillary serous carcinoma, 3 cases with endometrial clear cell carcinoma, and 7 cases with endometrial adenosquamous carcinoma. Results: Fifteen cases of endometrial carcinoma were performed operations after 3–4 weeks of intra-arterial chemotherapy and embolization. In these cases, 3 were found mass necrosis and lymphocyte cells infiltration in the tumor tissues but no carcinoma cells, which was noted as histological complete remission (HCR). After intra-arterial chemotherapy and embolization 3–4 weeks, the expression of proliferating cell nuclear antigen (PCNA) was obviously reduced (P < 0.001). Conclusion: The preoperative intra-arterial chemotherapy and embolization can improve the operability of resection in patients with aggressive subtype of endometrial carcinoma, reduce the expression of PCNA, adjust malignancy of endometrial carcinoma, and improve prognosis.
