CT-guided intratumoural administration of cisplatin/epinephrine gel for treatment of malignant liver tumours

Abstract

To analyze prospectively the interventional and clinical aspects of computed tomography-guided direct intratumoural injection of a novel chemotherapeutic administration and the parenchymal changes of tumour and necrosis in malignant liver tumours. Eight patients with 17 colorectal liver metastases were treated with a mean of 5.1 injections and nine patients with 13 hepatocellular carcinoma nodules with a mean of 3.1 treatments with computed tomography guided local applications of a novel cisplatin/epinephrine gel. This application provides a higher local and lower systemic drug concentration. Volumes of tumour and necrosis prior and after treatment were measured by computer generated volumetric analysis. Contrast enhanced studies verified pretherapeutic viable tumour volumes with a value of 77.4 ml in the metastases and 29.2 ml in the hepatocellular carcinoma nodules. Intratumoural drug application resulted in a significant increase of necrosis and a decrease in viable tumour volume to be 68.3 ml in metastases and 14.5 ml in hepatocellular carcinoma. Local therapy control rate for the follow up to 6 months was 38 and 71% for the group of metastases and hepatocellular carcinoma, respectively. Direct intratumoural injection of cisplatin/epinepthrine injectable gel is a feasible and good tolerated method and results in the development of a statistically significant increase in necrosis in malignant liver tumours. For hepatocellular carcinoma a higher local therapy control rate compared to colorectal metastases can be reported.

Treatment of hepatocarcinoma

“…Ethiodized oil is taken up by the tumor tissue at a higher rate than normal tissue; as a viscous medium, it slows down the blood flow and thus the cytotoxic drug wash-out, and by itself it results in embolization of the supplying arteries and venules through perisinusoidal anastomoses. The most commonly used cytotoxic drugs are doxorubicin and epirubicin, and cisplatin was recently used in a gelatinous matrix in combination with epinephrine to further retain the cytotoxic drug in the tumor bed [48,49]. In vitro testing of tumor cell sensitivity to these drugs has been proposed for better selection of the cytotoxic agent to be used in individual patients.…”

A phase III placebo-controlled study in advanced head and neck cancer using intratumoural cisplatin/epinephrine gel

“…In clinical experience with CDDP/epi gel in solid tumours, adverse effects typical of systemically administered cisplatin were rare and mild (Burris et al, 1998). Efficacy and clinical benefit of the drug for local tumour control has been demonstrated in phase II open-label trials for a variety of solid tumours including cutaneous and soft tissue metastases of malignant melanoma (Oratz et al, 2002), recurrent breast cancer (Roshon, 2001), oesophageal (Harbord et al, 2002), and gastric cancer (Monga et al, 1998), and primary and secondary malignant liver tumours (Leung et al, 2001;Thuluvath et al, 2001;Vogl et al, 2002).…”

Intratumoral NAMI-A Treatment Triggers Metastasis Reduction, Which Correlates to CD44 Regulation and Tumor Infiltrating Lymphocyte Recruitment

“…The great interest in i.t. drug administration is confirmed by the rising number of studies on animal models (Smith et al, 1999) and in clinical trials (Vogl et al, 2002). The therapeutic target of such site-specific treatment was a large variety of inoperable advanced malignant solid tumors.…”