Fine Needle Percutaneous Intratumoral Chemotherapy under Ultrasound Guidance: A Feasibility Study

Abstract

To test the feasibility of fine needle (22 gauge) percutaneous intratumoral chemotherapy (PIC) under ultrasound guidance, a trial was conducted on 12 selected neoplastic patients with tumors not responsive to conventional treatments (5 adenocarcinomas of the pancreas, 1 hepatocellular carcinoma, 1 squamous cell carcinoma of the lung, 1 leiomyosarcoma of the hepatic hilum, 1 malignant fibrous histiocytoma of the ischiatic region, 2 liver and 1 peritoneal metastases). The drugs used were 5-fluorouracil, methotrexate and cyclophosphamide, according to the histotype. The doses given never exceeded the routine intravenous doses; 119 sessions of PIC were administered. There have been no significant local complications due to needle injury and drug toxicity or biochemical changes attributable to general toxicity. Partial or total pain control and stable disease or response to 60% was observed. This research has not been described previously to our knowledge.

Promising therapeutic efficacy of a novel reduced expression in immortalized cells/dickkopf‐3 expressing adenoviral vector for hepatocellular carcinoma

“…Ad‐TK injection was feasible in all of the cases, and there were no severe adverse events. In this clinical study, the drug was administered via percutaneous injection, whose safety as a drug delivery method for the treatment of liver tumors has been reported . These studies established the safety of the adenovirus‐based gene therapy for HCC.…”

Bronchoscopic intratumoral chemotherapy of lung cancer

“…Since the 1986 paper by Livraghi et al, demonstrating successful ultrasound guided fine needle (22 gauge) percutaneous IT chemotherapy of a variety of cancers using 5-FU, methotrexate, and cyclophosphamide, numerous clinical IT studies have been reported [61]. Using computed tomography (CT) guidance, malignant liver lesions have been treated by percutaneous injection of mitoxantrone [62].…”

The “Trojan Horse” Approach to Tumor Immunotherapy: Targeting the Tumor Microenvironment

“…Direct injection has been performed on several human tumors under, for example, computed tomographic guidance. In humans, intratumoral injections have been successfully performed in melanoma [99], liver cancer [100], lung cancer [101–103], colorectal cancer [104], pancreatic cancer [105], cervical chordoma [106], Wilms' tumor and neuroblastoma [107], cystic craniopharyngioma [108], head and neck tumors [109], glioblastoma multiforme [110], and even in difficult to access tumors such as mesothelioma [111] that begin as discrete plaques and nodules and develops into a sheet-like neoplasm lining the pleural cavity [112]. …”