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Treatment of Metastatic Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Jürgen Weitz, Carina Riediger, Annika Stange, Ralf-Thorsten Hoffmann, David Morris
The use of adjuvant chemotherapy after resection of colorectal liver metastases is debated in the literature (see below). Hepatic arterial infusion (HAI) chemotherapy after liver resection is rarely used. Initially this method was a palliative treatment of liver metastases. A recent meta-analysis including 9 studies containing 1,057 patients showed an improved long-term survival of patients receiving HAI + chemotherapy compared to adjuvant systemic chemotherapy after curative liver resection. Furthermore, it has been shown that HAI can lead to secondary resectability of primary non-resectable colorectal liver metastases.18
Malignant Neoplasms of the Colon
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
Martin et al. (1008) examined the survival and toxicity of hepatic arterial infusion pump following resection and/or radiofrequency ablation of all liver metastases. Patients received FUDR via the hepatic artery infusion pump at standard doses. Complications were graded according to a standard five-point grading scale. Thirty-four of 86 patients underwent placement of hepatic artery infusion pump at the time of hepatic resection or ablation. The hepatic artery group demonstrated a significantly greater number (median 5 vs. 2) and size (median 5 cm vs. 3 cm) of hepatic lesions compared to the group without hepatic artery infusion pump. The hepatic artery infusion pump experienced a greater frequency of complications (53% vs. 33%), with 18% in the hepatic artery infusion pump group demonstrating biliary sclerosis. There were no deaths within 30 days of operation. Median survival was similar in both groups (hepatic artery infusion pump 20 months, no hepatic artery infusion pump 24 months). Adjuvant hepatic artery infusion chemotherapy was associated with significantly greater morbidity and given the availability of newer active systemic agents and regimens, the value of adjuvant hepatic artery infusion pump chemotherapy following hepatic resection or ablation remains controversial.
Poly(Alkyl Cyanoacrylate) Nanoparticles for Delivery of Anti-Cancer Drugs
Published in Mansoor M. Amiji, Nanotechnology for Cancer Therapy, 2006
R. S. R. Murthy, L. Harivardhan Reddy
A procedure for effective and promising preoperative embolization of carotid body tumors was reported by Harman et al.188 Ultrasound-guided direct percutaneous injection of n-butyl cyanoacrylate was given, and angiographic road map assistance was used for protection of parent arteries during the injection. After embolization, complete devascularization of the tumor was achieved without complications. The tumor was removed surgically with minimal blood loss. Transcatheter arterial embolization (TAE) of splanchnic arterial branches to allow continuous application of repeat hepatic arterial infusion chemotherapy (HAIC) was assessed.189 One hundred and twentyeight patients with unresectable advanced liver cancer were implanted with a percutaneous port catheter system and TAE of splanchnic arteries with coils and/or NBCA. The recanalization rate between coil-embolized and NBCA- or NBCA-coil-embolized arteries, and frequency of heterogeneously poor distribution was compared between patients with single arteries and those with multiple hepatic arteries. The arteries once embolized with coils alone spontaneously recanalized at a significantly higher rate than those with NBCA. A hepatic artery embolization study carried out by Loewe et al.186 using NBCA and ethiodized oil for the treatment of small-bowel neuroendocrine metastases to the liver for the treatment of liver metastases from neuroendocrine small-bowel tumors also concluded that the use of cyanoacrylate as an embolic agent is safe and effective.
Pancreatic Cancer: A Review of Current Treatment and Novel Therapies
Published in Journal of Investigative Surgery, 2023
Hordur Mar Kolbeinsson, Sreenivasa Chandana, G. Paul Wright, Mathew Chung
Hepatic arterial infusion (HAI) therapy involves placing a catheter into the hepatic arterial vasculature (via gastroduodenal artery) supplying the liver and infusing chemotherapy directly into the liver. The benefits of HAI manifest in lower systemic toxicity and higher gradient of chemotherapy in the liver using certain agents [101]. The benefits of HAI therapy in the setting of liver metastases from colorectal cancer have long been recognized [102]. A few small studies have been conducted with HAI utilized as adjuvant treatment [103–105] as well as for metastatic PDAC [106]. They all have shown benefits to some extent. The non-randomized trial by Wang et al. compared 43 patients receiving adjuvant 2 cycles HAI chemotherapy followed by 4 cycles systemic chemotherapy (both consisting of 5-FU and gemcitabine) to 44 patients receiving adjuvant systemic gemcitabine + 5-FU alone [105]. Although 5-year disease-free probability was the same for both groups, the HAI group had significantly better 5-year overall survival probability (hazard ratio (HR) 0.60) and hepatic metastases-free survival (HR 0.50). Ohigashi et al and Beger et al described 53% 3-year survival and 54% 4-year survival, respectively, with the use of HAI chemotherapy in the adjuvant setting [103, 104]. Another small study by Tajima et al on patients with hepatic recurrence after resection showed a response rate in 6 out of 7 patients (85%) [106]. There is currently a phase 2 trial ongoing using floxuridine-based HAI chemotherapy for patients with liver metastases after PDAC resection (NCT03856658).
Emerging treatment strategies in hepatobiliary cancer
Published in Expert Review of Anticancer Therapy, 2023
Deniz Can Guven, Hasan Cagri Yildirim, Elvin Chalabiyev, Fatih Kus, Feride Yilmaz, Serkan Yasar, Arif Akyildiz, Burak Yasin Aktas, Suayib Yalcin, Omer Dizdar
Hepatic arterial infusion chemotherapy (HAIC) enables a higher local chemotherapy concentration with fewer adverse effects than conventional systemic chemotherapy. Chemotherapy strategies often include an infusion of FOLFOX (folinic acid, fluorouracil, and oxaliplatin), cisplatin plus 5-fluorouracil, or cisplatin into the hepatic artery [89–91]. The long-term survival effect of preoperative HAIC has been proven, and it has been observed that around 12% of patients with HCCs that cannot be resected at baseline can undergo hepatectomy following treatment [92,93]. In addition, a meta-analysis by Li et al. showed that HAIC improves long-term survival for both resectable and unresectable HCC patients compared to other treatments [94]. Furthermore, it has been demonstrated that preoperative HAIC prevents intrahepatic distant recurrence in individuals with early stage HCC [95]. The results of ongoing NeoconceptA study (NCT04777942) are eagerly awaited in this regard.
Hepatic arterial infusion chemotherapy and sequential ablation treatment in large hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2022
Huimin You, Xingyi Liu, Jiandong Guo, Yinsheng Lin, Yan Zhang, Chengzhi Li
HAIC procedure has been described in the previous report [17]. The catheter was inserted into the femoral artery using the Seldinger technique and advanced into the celiac artery. A micro-catheter was inserted and located in the feeding hepatic artery. All procedures were performed using digital subtraction angiography (Philips, type FD 20 1250 mA, Amsterdam, the Netherlands). The artery sheath catheter was inserted into the femoral artery using the modified Seldinger technique. A 5-Fr Yashiro catheter (Terumo, Tokyo, Japan) was advanced into the celiac trunk and superior mesenteric artery to assess the feeding hepatic artery. 2.7-Fr micro-catheter (Terumo, Tokyo, Japan) was inserted in the feeding artery. The chemo-drugs were given by hepatic arterial infusion through the micro-catheter. A modified FOLFOX6 regimen, including oxaliplatin (130 mg/m2 infusion for 3 h on day 1), leucovorin (200 mg/m2 for 3–5 h on day 1) and Fluorouracil (400 mg/m2 in bolus, and then 2,400 mg/m2 continuous infusion 46 h) was applied. Treatment was repeated every 21 days and commonly 4–6 cycles unless intrahepatic lesions progressed or toxicity became unacceptable.