Improved survival for hepatocellular carcinoma with portal vein tumor thrombosis treated by intra-arterial chemotherapy combining etoposide,carboplatin,epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil:A pilo

AIM： To investigate the poor prognosis of HCC with PVTT, we evaluated the efficacy by a new combination chemotherapy for advanced hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVTT）. METHODS： From 2002 to 2007, a total of 10 consecutive patients with Stage IVA HCC accompanied by PVTT were studied prospectively to examine the efficacy of treatment by intra-arterial infusion of a chemotherapeutic agents consisting of etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil. RESULTS： The mean course of chemotherapy was 14.4 （range, 9-21） too. One patient showed complete response （CR） with disappearance of HCC and PVI-F after treatment, and the two patients showed partial response （PR）, response rate （CR ＋ PR/All cases 30%）. The median survival time after the therapy was 457.2 d. The one-year survival rate was 70%. Adverse reactions were tolerable.CONCLUSION： Although the prognosis of most patients with Stage IVA HCC by PVTT is poor, our combination chemotherapy may induces long-term survival and is an effective treatment and produced anti-tumor activity with tolerable adverse effects in patients for advanced Stage IVA HCC accompanied by PVTT.

Use of intra-arterial chemotherapy for retinoblastoma:results of a survey

·AIM: To obtain baseline knowledge about the current use of intra-arterial chemotherapy(SSOAIC) in centers worldwide.·METHODS: A survey including questions about the use of SSOAIC was emailed to retinoblastoma experts.·RESULTS:Seventy-nine(response rate 69.9%) doctors from 63 centers in 35 countries responded. Thirty-one centers from 19 countries use SSOAIC. Twelve performed more than 50 procedures. Melphalan is the most commonly used drug but 15 centers use more than one drug. First line therapy for advanced unilateral disease is the most common use of SSOAIC(74.2%). Centers with larger experience(】50 applications) were less likely using melphalan alone(P =0.06) and significantly more likely using SSOAIC in more situations such as second line in preference to radiotherapy P =0.05. Nineteen(61.2%)stated that SSOAIC improved their results and 21(77.8%)reported less toxicity compared to other treatments.Three centers reported that SSOAIC did not improve their results. There were regional variations in the use of SSOAIC which is used more frequently as secondary treatment in Europe compared to the USA and Japan.Ten centers identified cost is the major limiting factor for SSOAIC.· CONCLUSION: SSOAIC is used in an increasing number of centers worldwide with regional variations.Centers with more experience in SSOAIC use it in more situations including other drugs than melphalan. The majority of the centers using this technique reportedimproved results and few complications.

Combined intra-arterial chemotherapy and intravitreal melphalan for the treatment of advanced unilateral retinoblastoma

●AIM:To evaluate the efficacy and safety of combined intraarterial chemotherapy(IAC)and intravitreal melphalan(IVM)for the treatment of advanced unilateral retinoblastoma.●METHODS:This retrospective study involved 30 consecutive eyes from 30 Chinese patients with advanced unilateral retinoblastoma.All patients were initially treated with IAC combined with IVM.The clinical status and complications were recorded at each visit.●RESULTS:The International Intraocular Retinoblastoma Classification groups were D in 23 eyes and E in 7 eyes.All eyes showed severe cloud vitreous seeds at the first visit.The mean number of IAC cycles and intravitreal injections was 3.2(range,3-4)and 6(range,1-14),respectively.The median follow-up time was 29 mo(range,7-36 mo).Treatment success with regression of the retinal tumor and vitreous seeds was achieved in 29 of 30 eyes(96.7%).Globe salvage was attained in 93.3%(28/30)eyes,and enucleation(n=2)was per formed due to neovascular glaucoma and persistent vitreous hemorrhage.Complications included retinal pigment epithelium(RPE)atrophy(n=13;43%),mild lens opacity(n=7;23%),vitreous hemorrhage(n=5;17%)and rhegmatogenous retinal detachment(n=1;3%).No extraocular tumor extension or metastasis occurred.●CONCLUSION:Combined IAC and IVM is effective and safe for the treatment of advanced unilateral retinoblastoma.

Is it relevant that intra-arterial chemotherapy may be effective for advanced pancreatic cancer?

Unresectable pancreatic cancers have an extremely dismal prognosis and chemoresistant nature. The treatment of pancreatic cancer is still problematic. Gemcitabine is a promising new agent that has been studied recently for palliation of advanced pancreatic cancer. However,the response rates have been highly variable,and are often irreproducible. To improve this low response rate,various treatments are needed because no standard treatment exists. Intra-arterial chemotherapy is considered to take advantage of the first pass effect of the drug,generating higher local drug concentrations in tumor cells with lower toxicity. Regional intra-arterial chemotherapy may provide high levels of cytostatic concentrations within the tumor and,simultaneously,a low rate of systemic side effects compared with systemic administration of anti-neoplastic drugs. Intra-arterial chemotherapy has been introduced as an alternative treatment for advanced pancreatic cancer. Further clinical trials of this method should be subjected to a prospective randomized controlled study for advanced pancreatic cancer.

Efficacy of second-course intra-arterial chemotherapy in children for advanced retinoblastoma recurrence after intra-arterial chemotherapy

Purpose: The present study determined the efficacy and toxicity of second-course intra-arterial chemotherapy(IAC) in advanced retinoblastoma(RB) recurrence in children following failed initial IAC. Materials and Methods: A total of 24 child patients with unilateral or bilateral intra-ocular advanced RB(IIRC Group D and Group E) undergoing second-course IAC treatment after initial intra-arterial chemotherapy between September 2011 and November 2016 were enrolled. Global salvage, ocular adverse events, and systemic adverse events were assessed. Results: Following second-course IAC, 15(62.5%) showed complete control at 34 months follow-up, while 8 cases(33.3%) failed the treatment and 1 patient with metastatic disease(4.2%) eventually died of brain metastasis after refusing treatment. Ocular adverse events included eyelid edema(n=12), ptosis(n=5), forehead erythema(n-5), enophthalmos(n=3), and cataract(n=2). None of the patients had systemic adverse events, such as stroke or sepsis. Also, no secondary neoplasms and technical complications were observed. Conclusion: Second-course IAC is a potential alternative to enucleation in children with advanced RB, who fail an initial course of IAC. However, patients with advanced RB should be managed at experienced centers in order to consider all the alternatives before enucleation.

Prognostic value of post-treatment ^(18)F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy

Objective：To clarify the prognostic value of post-treatment 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） in patients with advanced head and neck squamous cell carcinoma （HNSCC） after combined intra-arterial chemotherapy and radiotherapy （IACR）.Methods：Thirty-six patients with HNSCC who underwent IACR were recruited.The period from the end of IACR to the last post-treatment 18F-FDG PET/CT examination was 8-12 weeks.Both patient-based and lesion-based analyses were used to evaluate the PET/CT images.For lesion-based analysis,36 regions （12 lesions of recurrences and 24 scars at primary sites） were selected.The Kaplan-Meier method was used to assess the overall survival （OS） stratified by 18F-FDG uptake or visual interpretation results.Results：Twelve patients with recurrence were identified by six months after IACR.The sensitivity and specificity in the patient-based analysis were 67％ （8/12） and 88％ （21/24）,respectively.The mean OS was estimated to be 12.1 months （95％ CI,6.3-18.0 months） for the higher maximum standardized uptake value （SUVmax） group （n=7） and 44.6 months （95％ CI,39.9-49.3 months） for the lower SUVmax group （n=29）.OS in the higher SUVmax group （cut-off point,6.1） or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group （P＜0.001 and P＜0.05,respectively）.Conclusions：The SUVmax and visual interpretation of HNSCC on post-IACR 18F-FDG PET/CT can provide prognostic survival estimates.

CLINICAL COMPARISON OF THE SELECTIVE SEROTONIN_3 ANTAGONISTS RAMOSETRON AND GRANISETRON IN TREATING ACUTE CHEMOTHERAPY-INDUCED EMESIS,NAUSEA AND ANOREXIA

Feng Fengyi , Zhang Pin , He Youjian 1, Li Yuhong1 , Zhou Meizhen2 , Chen Gang2 and Li Lin2 The Cancer Hospital of the CAMS & PUMC, Beijing 1000211 The Cancer Hospital of Sun Yat Sen University of Medical Sciences, Guangzhou 5100602Beijing Hospital of the Ministry of Health, Beijing 100730

HIGH DOSE INTRA-ARTERIAL HEPATIC INFUSIONAL CHEMOTHERAPY WITH DRUG FILTRATION (HAI-F) FOR PRIMARY LIVER CANCER(A PRELIMINARY REPORT)

Fifteen patients with unresectable hepatocellular carcinoma were treated with unresectable hepatocellular carcinoma were treated with high dose MMC or ADR via hepatic artery with drug filtration in our hospital from April to December 1988. Among them, 11 cases (73%) had symptoms relief, 3 cases (20%) tumor minimal remission and AFP decreased in 4 cases (33%). One case dide of hep'atoma 8 months after HAI-F and another case was followed up only 2 months after treatment, the remaining 13 cases are alive for 5 to 10 months after HAI-F. The reasons of unsatisfactory results were analyzed and possible ways of improvement were suggested.

Neoadjuvant intra-arterial infusion chemotherapy followed by surgery in patients with locally advanced cervical cancer

Objective： The aim of this study was to investigate the role of preoperative neoadjuvant intra-arterial infusion chemotherapy （NAIC） in treating locally advanced cervical caner. Methods： Nineteen locally advanced cervical cancer （LACC） patients from November 2003 to November 2005 were analyzed retrospectively. NAIC was administrated 2 courses every 2 weeks using a combination of 30 mg/m^2 bleomycin and 50 mg/m^2 cisplatin via bilateral femur artedes. The response to NAIC was assessed by pelvic examination and imaging diagnostics and histological analysis. Two weeks after NAIC radical hysterectomy with pelvic lymphadenectomy was performed. Results： Radical hysterectomy with pelvic lymphadenectomy were performed in 18 patients successfully. The mean tumor reduction rate was 73.04%. The overall clinical response rate of NAIC was 84.2% with 2 complete responses and 16 partial responses. Only 1 nonresponder. Six of 7 cases who had parametrial infiltration had a absence after chemotherapy, no significant change was observed in 1 case who followed by radiotherapy. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was determining factor affecting the efficacy of NAIC in LACC. Conclusion： pre-operative NAIC inhibited the growth of LACC, minimized the size, eliminate effectively the pathologic dsk factors in the pelvic cavity, to improve the operability in cervical cancer patients with stage lib or above, considered inoperable.

Intra-Arterial Chemotherapy for Retinoblastoma

The management of retinoblastoma is challenging and complex. Preservation of the eyeball as well as vision, with minimum morbidity, is the aim in the initial stages. This has been made possible by the use of chemotherapy that is targeted to the eye in the form of selective intravitreal and intra-arterial chemotherapy which has shown promising results. The efficacy and safety of intra- arterial chemotherapy have been reported by many specialized centers. The aim of this article was to review the role of intraarterial chemotherapy in the management of retinoblastoma and its clinical outcomes. In addition, we will review the possible complications of the procedure. We were able to collect articles relevant to our research objectives by reviewing the title and abstract of each article. Irrelevant articles and those that did not meet the inclusion criteria were excluded. This yielded a total of 19 studies. The results indicated that intraarterial chemotherapy is an effective and new modality of treatment for retinoblastoma to salvage the eyeball and helps in the prevention of enucleation with minimal local and systemic complications that are mostly transient. For future work, we recommend conducting more prospective studies with large samples and the long duration of follow-up. Also, we recommend future studies focusing on assessing visual acuity, as most of the currently available studies did not assess the visual acuity, making the judgment on vision preservation with IAC difficult.

Twenty-four hour intra-arterial infusion of 5-fluorouracil,cisplatin,and leucovorin is more effective than 6-hour infusion for advanced hepatocellular carcinoma

AIM. To evaluate the time dependence of intra-arterial 5-fluorouracil （5-FU） therapy for advanced hepatocellular carcinoma （aHCC）. METHODS： Thirty-seven adult Japanese patients who had aHCC and liver cirrhosis were treated with combined intra-arterial 5-FU, cisplatin （CDDP）, and leucovorin （LV）. The Japan Integrated Staging score （JIS score） of each patient was 3 or more. The patients were divided into two groups, alter which the 15 patients in group S were treated with 6-h infusion chemotherapy （LV at 12 mg/h, CDDP at 10 mg/h, and 5-FU at 250 mg/m^2 per 4 h） and the 22 patients in group L were treated with 24-h infusion chemotherapy （LV at 12 mg/h, CDDP at 10 mg/h, and 5-FU at 250 mg/m^2 per 22 h）. Continuous infusion chemotherapy was performed v/a the proper hepatic artery every 5 d for 4 wk using an implanted drug reservoir. RESULTS： The percentages of patients with a partial response after 4 wk of chemotherapy were 6.7% in group S and 31.8% in group L. The survival of group L was significantly better than that of group S, with the median survival time being 496 d in group L and 226 d in group S （P 〈 0.05）. CONCLUSION： Continuous 24-h intra-arterial infusion is more effective for aHCC and can markedly prolong survival time as compared to 6-h infusion.

Selection criteria for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

Peritoneal carcinomatosis in gastric cancer is associated with a dismal prognosis.Systemic chemotherapy is not effective because of the existence of a blood-peritoneal barrier.Cytoreductive surgery and intraperitoneal chemotherapy can improve survival and quality of life in selected patients.Patient selection for this multimodal approach is one of the most critical issues,and calls for interdisciplinary evaluation by radiologists,medical and surgical oncologists,and anaesthetists.This article sets forth criteria for selection of gastric cancer patients suffering from peritoneal carcinomatosis.

Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer

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.

Pharmacokinetic comparison between ultraselection of uterine artery and peripheral vein chemotherapy of carboplatin in cervical cancer

Objective:The present study is to compare pharmacokinetics difference of carboplatin by using ultraselection uterine artery with by using peripheral vein in cervical cancer.Methods:Thirteen patients with locally advanced cervical cancer who had been proved by pathobiology were randomly divided into two groups:the ultraselection uterine artery group(group A, n = 6) and the peripheral vein(group B, n = 7).Carboplatin was administered by infusing into artery or vein in both groups at the dosage of 300 mg/m2.Tissues from the cervical tumor were collected at different times after infusion in both groups and then analyzed.Results:The peak concentration of platinum in tumor tissue was about 2.79 times higher in group A than that of group B(P < 0.05).The platinum concentrations in tumor in group A reached its peak levels immediately after infusion.But, group B had delayed time.While, for the time point of 0 min, when the administration finished immediately, the platinum concentration in tumor was significantly higher when compared with group B(P < 0.05).The tumor tissue area under the concentration(AUC) of carboplatin was about 2 times higher in group A than that of group B(P < 0.05).Conclusion:We observed the pharmacological advantages of chemotherapy by using ultraselection uterine artery administration of chemotherapeutic agent carboplatin in tumor tissue which provided theoretical basis and laboratory parameters of the intra-arterial chemotherapy for gynecologic malignancy.

Successful Treatment of Intra-Arterial Peplomycin Infusion for Recurrent Oral Florid Papillomatosis

A 56-year-old woman had noticed the erosion of oral mucosa and tongue 8 years ago. The mucosal lesions had been initially diagnosed as oral lichen planus and resistant to various treatments with prednisolone, etretinate and mizoribine and so on. One year ago, rapidly growing verrucous lesion occurred on her upper lip. Although we administered intralesional radiation therapy, the tumor recurred and new whitish lesions on the buccal mucosa and hard palate occurred 9 months after treatment. We confirmed an anatomical blood supply to the tumors by a fluorescent real-time imaging system and subsequently administered the intra-arterial infusion of peplomycin through retrograde catheters from bilateral superficial temporal arteries under the final diagnosis as oral florid papillomatosis (OFP). The tumors were dramatically shrunk and did not recur 16 months after treatment. OFP is known as clinically multiple whitish and verrucous lesions over the oral cavity and lip and a subtype of SCC with high differentiation. We suppose that an intra-arterial infusion therapy of peplomycin should be considered as the curative treatment for OFP.

基于数据挖掘探讨耳穴疗法治疗化疗相关性恶心呕吐选穴规律

目的探索耳穴疗法治疗化疗相关性恶心呕吐(CINV)的选穴规律。方法检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)和PubMed数据库自建库至2023年9月5日耳穴疗法治疗CINV相关文献,采用Excel2019建立数据库并统计耳穴使用频次,利用SPSS Modeler 18.0软件进行关联规则分析,利用SPSS Statistics 25.0软件进行层次聚类分析,采用Cytoscape3.9.1软件展示耳穴共现网络。结果纳入文献201篇,涉及耳穴治疗方法4种,涉及耳穴27个,常用耳穴有胃、神门、交感、脾、皮质下等;关联规则分析得到以神门、胃、交感、脾为核心的穴组;聚类分析得到6个有效聚类群。结论耳穴治疗CINV选穴多以局部取穴结合西医神经、内分泌功能调节取穴为主,结合疏利肝胆、食道,通腑降浊等加强作用。

基于子午流注理论的八段锦结合耳穴贴压对肿瘤化疗患者心理状态的影响

目的:探讨基于子午流注理论的八段锦结合耳穴贴压对肿瘤化疗患者心理状态的影响。方法:选取2023年1—12月晋江市医院收治的80例肿瘤化疗患者,随机分为两组。对照组(n=40)进行常规护理干预,观察组(n=40)在对照组基础上进行基于子午流注理论的八段锦结合耳穴贴压护理干预。分析比较两组心理状态、癌因性疲乏、生活质量及护理满意度。结果:观察组干预后生活质量评分和护理总满意度均高于对照组(P<0.05)。干预后,观察组癌因性疲乏、心理状态评分均低于对照组(P<0.05)。结论:肿瘤化疗患者采用基于子午流注理论的八段锦结合耳穴贴压护理,可以改善患者的心理状态,提高生活质量,减轻癌因性疲乏,提升护理满意度。

选择性动脉灌注化疗栓塞联合全身化疗治疗晚期食管癌的临床研究

目的评价选择性动脉灌注化疗栓塞术(SAPCT)联合全身化疗(SC)治疗晚期食管癌的短期及远期疗效及安全性。方法选取2017年6月至2019年6月该院收治的112例晚期食管癌患者,将其分为试验组(57例)和对照组(55例)。试验组患者给予SAPCT联合SC(5-氟尿嘧啶/顺铂方案)治疗,对照组患者给予SC(5-氟尿嘧啶/顺铂方案)治疗,2组患者均化疗2个周期。对比2组患者短期、远期临床疗效及不良反应发生情况。结果化疗1周期后,试验组患者吞咽困难缓解程度明显优于对照组,差异有统计学意义(P<0.05)。化疗2周期后,试验组患者部分缓解率和进展率优于对照组,差异均有统计学意义(P<0.05);试验组患者远期疗效PFS和OS优于对照组,差异均有统计学意义(P<0.001)。结论SAPCT联合SC治疗晚期食管癌不仅可以明显缓解患者吞咽困难症状,而且可显著改善患者的预后。

Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients

Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.

How to improve metastatic pancreatic ductal adenocarcinoma patients’selection:Between clinical trials and the real-world

As underlined in the minireview by Blomstrand et al,given the poor prognosis and the paucity of data on a therapeutic sequence in pancreatic ductal adenocarcinoma(PDAC),additional randomized controlled trials and real-world evidence studies addressing current and novel regimens are needed.The real-world outcomes of first-line chemotherapy regimens such as FOLFIRINOX and gemcitabine/nab-paclitaxel are thoroughly reviewed and seem to be largely generalizable in a real-world context.Regarding second-line chemotherapy,the key question about the optimal sequence of regimens remains uncertain.Precisely in this setting,it is therefore useful to encourage the implementation of clinical studies that may contribute to the scarcity of data available up to now.We report our experience with a small group of patients treated with second-line liposomal irinotecan(nal-IRI)plus 5-fluorouracil and leucovorin.To improve the treatment of patients affected by PDAC,it is useful to identify subgroups of patients who may benefit from target treatments(e.g.,BRCA mutant)and it is also important to focus on any prognostic factors that may affect the survival and treatment of these patients.