Interventional Radiologists Provide Localized Chemotherapy to Spare
Healthy Tissue (See http://www.sirweb.org/ )


News Highlights From August's Journal of Vascular and
Interventional
Radiology (JVIR)

Study Identifies Patients With Advanced Liver Cancer That May
Benefit
From Minimally Invasive Chemotherapy Infusion Directly to the
Liver

FAIRFAX, Va., Aug. 17 /PRNewswire/ -- In this retrospective
study, eighty-
eight patients with advanced hepatocellular carcinoma (HCC) were
treated with
long-term chemotherapy infusion into the hepatic artery, the main
artery that
supplies the liver. Known as hepatic arterial chemotherapy, this
treatment
requires a reservoir/pump system to supply the drug directly to the
liver and
the liver cancer. The reservoir port systems currently available
have to be
surgically implanted, making this treatment unavailable to many
patients who
were unable or unwilling to have the implant. Interventional
radiologists --
vascular experts who are uniquely skilled in using the vascular
system to
deliver targeted treatments via catheter throughout the body --
adapted
conventional venous ports to use in the arterial circulation. In
this method,
the interventional radiologist implanted the reservoir and then
embolized --
mechanically blocked -- the arteries to the adjacent areas during the
port
placement to prevent the influx of drugs to areas outside of the
liver. This
is beneficial because the chemotherapy drug is only circulated to the
organ
with the cancer, so the drug does not harm healthy tissue throughout
the body.
This allows for a higher dose of chemotherapy drug to be used,
because the
drug is contained.

Hepatic Arterial Infusion Chemotherapy
The hepatic arterial infusion chemotherapy was initiated after
reservoir
implantation on an outpatient basis. The infusion protocols were
decided for
each patient by the physician in charge and chemotherapeutic agents
were
administered every 1-4 weeks. In 55 patients, cisplatin (10 mg/m2)
and 5-
fluorouracil (1,000 mg/m2) were given at 1 hour and 5 hours,
respectively. In
the other 33 patients, doxorubicin hydrochloride or epirubicin
hydrochloride
(10-20 mg/m2) were injected every 2-4 weeks in a "one-shot" manner.

Implantation of Reservoir and Response to Arterial Infusion
Chemotherapy
Reservoirs were successfully implanted in all patients. Arterial
infusion
chemotherapy was performed 13.1 times per patient on average. Tumors
completely disappeared in one patient (complete response, 1%), shrunk
at least
50% in maximum diameter in 14 patients (partial response, 16%),
shrunk 25%-50%
in five patients (minor response, 6%), and remained stable in 68
patients
(77%). No tumors showed progression. The tumor response rate
(complete and
partial responses) was 17%.

Survival
The follow-up period ranged from 1.4 months to 41.4 months, with
a mean of
12.0 months. The estimated 1-, 2-, and 3-year survival rates were
55%, 36%,
and 24% in all patients, with a mean survival period of 19.5 months
+/- 1.9.
This study showed similar results as those achieved in previous
studies.
The therapeutic response rate, 1-year survival rate, and mean
survival time
were 17%, 55%, and 19.5 months, respectively. By comparison, Okuda
et al,
analyzed the natural history of HCC and reported the prognoses of
untreated
patients. The median survival times were 0.7 months in patients with
Okuda
stage III disease, 2.0 months in those with stage II disease, and 8.3
months
in those with stage I disease. The survival of patients with portal
venous
invasion has been reported to be 3-4 months. Arterial infusion
chemotherapy
seems to improve survival in patients with HCC. In the present
study, the
mean survival periods were more than 1 year even in patients with
Okuda stage
II/III disease (15 months) and in those with portal venous invasion
(16
months).

Prognostic Factors Identified
In the univariable analysis, the following eight variables were
significantly linked with better prognosis: (i) tumor extension less
than 50%
of liver volume, (ii) CLIP score 0-2, (iii) Okuda stage I, (iv)
alkaline
phosphatase level of less than 140 IU/L, (v) absence of ascites, (vi)
aspartate aminotransferase level less than 80 IU/L, (vii) good
therapeutic
response, and (viii) lack of portal venous invasion. When multiple
variables
were analyzed, the CLIP score, Okuda stage, and therapeutic effect
were found
to be significant prognostic factors with independent value for
survival.
Although these results should be confirmed in future prospective
studies,
these prognostic factors should prove helpful in determining which
patients
with advanced HCC may benefit from arterial infusion chemotherapy
with an
implanted port system.

About HCC Cancer and Treatments
This study was conducted in Japan, but this treatment is also
being
performed in some institutions in the U.S. Until arterial port
systems are
designed and commercially available, this treatment would not be
widely
available or mainstream. However, long term infusion into the
hepatic artery
is a well-established principal in cancer treatment and this is a
promising
area of research. Surgical removal of liver tumors offers the best
chance for
a cure. Unfortunately, liver tumors are often inoperable because the
tumor
may be too large, or has grown into major blood vessels or other vital
structures. Almost 80 percent of patients are not candidates for
surgery
because HCC is usually advanced in patients with underlying liver
disease.

About the Society of Interventional Radiology
Interventional radiologists are board-certified physicians who
specialize
in minimally invasive, targeted treatments performed using imaging for
guidance to treat disease non-surgically through the blood vessels or
through
the skin. Interventional radiologists pioneered modern medicine with
the
invention of angioplasty and the catheter-delivered stent, which were
first
used to treat peripheral arterial disease. Interventional radiology
procedures are a major advance in medicine that do not require large
incisions
-- only a nick in the skin -- and offer less risk, less pain and
shorter
recovery times compared to open surgery. More information can be
found at
http://www.SIRweb.org.

Visit http://www.jvir.org to view the article.



SOURCE Society of Interventional Radiology
Web Site: http://www.sirweb.org http://www.jvir.org