Intra-Arterial Continuous Infusion for Treatment of Pancreatic and Biliary Tract Cancer: A Dose-Escalation Study of Fluorouracil Combined with Gemcitabine

Zanon, Claudio; Alabiso, Oscar; Grosso, Maurizio; Buosi, R.; Chiappino, Isabella; Clara, Renzo; Satolli, Antonietta; Zai, Silvia; Bortolini, Massimiliano; Botta, Mario; Mussa, Antonio

doi:10.1385/ijgc:27:3:225

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…5 Gemcitabine has shown antitumor activity in patients with carcinoma of the pancreas and is widely used as first-line chemotherapy in the treatment of this disease. However, despite superior activity compared with 5-FU, the result achieved with single-agent gemcitabine in pancreatic cancer is still poor (reported response rate of 5.4%, a median survival time of 5.65 months, and a 1-year survival rate of 18%).…”

Section: Discussionmentioning

confidence: 99%

5-Fluorouracil Intra-arterial Infusion Combined With Systemic Gemcitabine for Unresectable Pancreatic Cancer

Kanemitsu¹,

Tsuji²,

Tanaka³

et al. 2005

Pancreas

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Section: Discussionmentioning

confidence: 99%

5-Fluorouracil Intra-arterial Infusion Combined With Systemic Gemcitabine for Unresectable Pancreatic Cancer

Kanemitsu¹,

Tsuji²,

Tanaka³

et al. 2005

Pancreas

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“…Using implanted arterial ports, Zanon et al42 conducted a study to determine the maximum tolerable dose (MTD) of i.v. gemcitabine in combination with a continuous intraarterial (IA) infusion of 5‐FU in patients with advanced pancreatic cancer or biliary cancer.…”

Section: Gemcitabine With Infusional 5‐fumentioning

confidence: 99%

Gemcitabine in combination with 5-fluorouracil with or without folinic acid in the treatment of pancreatic cancer

Oettle

Riess

2002

Cancer

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“…In patients suffering from tumors of the head of pancreas with synchronous liver metastases, the catheter was placed into the hepatic artery and a hole was performed proximally, at the origin of the gastroduodenal artery, to deliver drugs into both the arteries (Hole & Tip technique). The gastroepiploic artery was embolized with Gianturco coils (30). Patients can be discharged within two hours with the prescription of low molecular weight heparin at prophylactic dosage until the removal of the catheter.…”

Section: Techniquementioning

confidence: 99%

“…Surgical stress, the need for an adequate vascular anatomy, the risk of life-threatening complications and the irreversibility of the procedure are well known disadvantages of the surgical implant. A percutaneous transaxillary implant technique has recently been introduced into clinical practice (25)(26)(27)(28)(29)(30) and represents the solution for overcoming both patient distress and irreversibility of the traditional laparotomic procedure. Furthermore, the percutaneous procedure with embolizations of aberrant vessels allows implantation of the catheter even in the presence of several anatomical variations in the so-called standard hepatic vascular anatomy.…”

mentioning

confidence: 99%

“…In Italy, an innovative device for percutaneous arterial Port-a-cath implantation in local anaesthesia with the aid of fluoroscopy has been applied since 1996. That experience represents the most important application of a percutaneous technique in Western countries to date (28)(29)(30). The need for a Japanese technique modification was and is due to two main factors: the complexity of the Arai procedure and the illegal use of glue in Western countries to block the catheter tip into the gastroduodenal artery as described in the Arai technique.…”

mentioning

confidence: 99%

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Past, Present and Future of Long-Term Hepatic Arterial Accesses with Implantable Ports

et al. 2001

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Intra-Arterial Hepatic Chemotherapy (IAHC) with floxuridine (FUdR) is an effective treatment for unresectable hepatic metastases from colorectal cancer, providing higher response rates than systemic treatments (1,2). The administration of IAHC requires a long-term vascular access to the hepatic arterial stream. Following a few anecdotal reports, in 1970 Watkins (3) published an extensive and detailed description of the surgical technique for implanting an indwelling catheter into the hepatic artery via the gastroduodenal artery for the administration of regional chemotherapy in patients affected by liver metastases from colorectal cancer. The original technique described the implantation of an external catheter with the tip placed into the lumen of the hepatic artery. However, a high incidence of device-related complications was reported, including catheter occlusion and vascular thrombosis. During the 80s, subcutaneous totally implantable reservoirs or infusion pumps were connected to a silicone catheter provided with a suture bead (4); the technique was modified by placing the tip of the catheter at the confluence between the gastroduodenal artery and the hepatic artery without causing any resistance to the regular arterial flow towards the liver. These changes in both the device and the surgical technique decreased the incidence of catheter occlusion, vascular thrombosis and infections, thus allowing an improvement in the results of locoregional hepatic treatments. Since then, partially or totally implantable devices with an indwelling catheter placed into the hepatic arterial stream have been extensively used for different purposes, including palliative treatment of unresectable lesions (5), adjuvant therapy after liver resection (6,7), and neoadjuvant therapy for tumor downstaging prior to surgery (8). However, the ever increasing experience in the field of surgically placed, long-term arterial accesses has been leading surgeons and oncologists to face up to the complications and limits of this approach. Complications secondary to surgically implanted arterial devices include mostly catheter occlusion and displacement (8.4% among infusion pumps and 21.6% among subcutaneous reservoirs) (9), hepatic artery thrombosis (1.4-8.1%) (9-12), device infection (1.1-4.4%) (9-12), decubitus of the catheter (11, 13), and other rare adverse events (i.e. hepatic artery-biliary fistula) (14). Furthermore, the traditional surgical technique requires a laparotomy and includes a meticolous dissection of the hepatic hilum with exposure of the hepatic arterial axis from the origin of the gastroduodenal artery up to the biforcation of the common hepatic artery and the so-called gastroduodenal de-vascularization. This approach of implanting the catheter into the hepatic artery has so far represented a significant limiting factor in an extensive application of IAHC in patients with metachronous metastatic liver disease. In such cases, indeed, an extensive surgical procedure whose only purpose is the implantation of a device may be...

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Intra-Arterial Continuous Infusion for Treatment of Pancreatic and Biliary Tract Cancer: A Dose-Escalation Study of Fluorouracil Combined with Gemcitabine

Abstract: 5-Fluorouracil intra-arterial continuous infusion, combined with systemic gemcitabine, seems to be a feasible and safe regimen that could give interesting results in pancreatic cancer.

Cited by 11 publications

References 19 publications

5-Fluorouracil Intra-arterial Infusion Combined With Systemic Gemcitabine for Unresectable Pancreatic Cancer

5-Fluorouracil Intra-arterial Infusion Combined With Systemic Gemcitabine for Unresectable Pancreatic Cancer

Gemcitabine in combination with 5-fluorouracil with or without folinic acid in the treatment of pancreatic cancer

Past, Present and Future of Long-Term Hepatic Arterial Accesses with Implantable Ports

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