Abstract
Continuous regional chemotherapy for treating hepatic tumors is a rational pharmacological approach as palliative treatment in selected patients, such as those with hepatocellular carcinoma and metastatic colorectal carcinoma. Continuous regional chemotherapy has the following advantages: (1) it delivers a higher concentration of drug directly to the liver tumor since it avoids a dilutional effect that otherwise occurs with a systemic (intravenous) injection; (2) many antimetabolites have a more effective antineoplastic effect when administered by a chronic infusion rather than by pulse injection; (3) there is significant hepatic extraction of many drugs when injected directly into the hepatic circulation, particularly fluorodeoxyuridine (FUdR) and to a lesser extent 5-fluorouracil (5-FU), mitomycin C, and adriamycin; this further increases the concentration of the drug at the site of the liver neoplasm; and (4) continuous infusion (either intraarterially or intravenously) has a lower peak serum concentration, thus decreasing toxicity such as marrow depression with FUdR and 5-FU, or cardiotoxicity with adriamycin [15, 19, 22, 29]. There are some disadvantages to this approach as well. First, there is less systemic exposure of the drug so that metastases at extrahepatic sites are not treated to the same degree. Second, there can be significant local toxicity, especially chemical hepatitis, cholecystitis, and gastritis.
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References
Ansfield FJ, Ramirez G, Davis HL, Jr, Wirtanen GW, Johnson RO, Bryan GT, Manalo FB, Borden EC, Davis TE, Esmaili M (1975) Further clinical studies with intrahepatic arterial infusion with 5-fluorouracil. Cancer 36: 2413
BalchCM, UristMM (1983) Vollständig implantierbare Infusionspumpe. Eine neue Behandlungsmöglichkeit für ausgewählte Patienten mit Lebertumoren. Dtsch Med Wochenschr 108: 1008
Balch CM, Urist MD, McGregor ML (1983a) Continuous regional chemotherapy for metastatic colorectal cancer using a totally implantable infusion pump: a feasibility study in 50 patients. Am J Surg 145: 285
BalchCM, UristMM, SoongS-J, McGregor ML (1983b) A prospective phase II clinical trial of continuous FUDR regional chemotherapy for colorectal metastases to the liver using a totally implantable drug infusion pump. Ann Surg 198: 567
BaroneRM, ByfieldJE, GoldfarbPB, Frankel S, Ginn C, Greer S (1982) Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastases. Cancer 50: 850
Blackshear PJ (1979) Implantable drug-delivery systems. Sci Am 241: 66
Blackshear PJ, Dorman FD, Blackshear PLJr, Varco RL, Buchwald H (1972) The design and initial testing of an implantable infusion pump. Surg Gynecol Obstet 134: 51
Cady B (1973) Hepatic arterial patency and complications after catheterization for infusion chemotherapy. Ann Surg 178: 156
Cady B, Oberfield RA (1974) Regional infusion chemotherapy of hepatic metastases from carcinoma of the colon. Am J Surg 127: 220
Clouse ME, Ahmed R, Ryan RB, Oberfield RA, McCaffrey JA (1977) Complications of long-term transbrachial hepatic arterial infusion chemotherapy. AJR 129: 799
Cohen AM (1984) Massachusetts General Hospital Infusaid pump experience. Presented at thirteenth annual cancer course: infusional cancer chemotherapy. Techniques and clinical trials in systemic and regional chemotherapy. Harvard Medical School, March 1–3
Cohen AM, Greenfield A, Wood WC, Waltman A, Novelline R, Athanasoulis C, Schaeffer NJ (1983 a) Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump. Cancer 51: 2013
Cohen AM, Kaufman SD, Wood WC, Greenfield AJ (1983 b) Regional hepatic chemotherapy using an implantable drug infusion pump. Am J Surg 145: 529
Dorr RT, Trinca CE, Griffith K, Dombrowsky PL, Salmon SE (1979) Limitations of a portable infusion pump in ambulatory patients receiving continuous infusions of anticancer drugs. Cancer Treat Rep 63: 211
Ensminger WD, Rosowsky A, Raso V, Levin DC, Glode M, Come S, Steele G, Frei E III (1978) A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2’-deoxyuridine and 5-fluorouracil. Cancer Res 38: 3784
Kemeny N (1983) The systemic chemotherapy of hepatic metastases. Semin Oncol 10: 148
Kemeny N (1984) A randomized study of intrahepatic vs systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. Presented at thirteenth annual cancer course: infusional cancer chemotherapy. Techniques and clinical trials in systemic and regional chemotherapy. Harvard Medical School, March 1–3
Lahr CJ, SoongS-J, Cloud G, Smith JW, UristMM, Balch CM (1983) A multifactorial analysis of prognostic factors in patients with liver metastases from colorectal carcinoma. J Clin Oncol 1: 720
Legha SS, Benjamin RS, Mackay B, Ewer M, Wallace S, Valdivieso M, Rasmussen SL, BlumenscheinGR, FreireichEJ (1982) Reduction of doxorubicin cardiotoxicity by prolonged continuous intravenous infusion. Ann Int Med 96: 133
Levin B (1984) Therapy of metastatic colorectal cancer with hepatic artery infusion chemotherapy using a subcutaneous implanted pump: University of Chicago experience. Presented at thirteenth annual cancer course: infusional cancer chemotherapy. Techniques and clinical trials in systemic and regional chemotherapy, Harvard Medical School, March 1–3
LokichJJ (1983) Determination of response in treatment of hepatic neoplasia. Semin Onco110: 228
LokichJJ (1984) Hepatic artery chemotherapy: the relative importance of direct organ distribution vs. the constant-infusion schedule. American J Clin Onco17: 125
NiederhuberJE, Ensminger WD (1983) Surgical considerations in the management of hepatic neoplasia. Semin Onco110: 135–147
NiederhuberJE, Ensminger WD, Gyves J, Thrall J, Walker S, Cozzi E (1984) Regional chemotherapy of colorectal cancer metastatic to the liver. Cancer 53: 1336–1343
OberfieldRA, McCaffrey JA, Polio J, Clouse ME, HamiltonT (1979) Prolonged and continuous percutaneous intra-arterial hepatic infusion chemotherapy in advanced metastatic liver adenocarcinoma from colorectal primary. Cancer 44: 414
Patt YZ, Mavligit GM, Chuang VP, Wallace S, Johnston S, Benjamin RS, Valdivieso M, Hersh EM (1980) Percutaneous hepatic arterial infusion (HAI) of mitomycin C and floxuridine (FUDR): an effective treatment for metastatic colorectal carcinoma in the liver. Cancer 46: 261
PetrekJA, MintonJP (1979) Treatment of hepatic metastases by percutaneous hepatic arterial infusion. Cancer 43: 2182
Reed ML, Vaitkevicius VK, Al-Sarraf M, Vaughn CB, Singhakowinta A, Sexon-Porte M, Izbicki R, Baker L, StraatsmaGW (1981) The practicality of chronic hepatic artery infusion therapy of primary and metastatic hepatic malignancies: ten year results of 124 patients in a prospective protocol. Cancer 47: 402
Seifert P, Baker LH, Reed ML, Vaitkevicius VK (1975) Comparison of continuously infused 5-fluorouracil with bolus injection in treatment of patients with colorectal adenocarcinoma. Cancer 36: 123
Sullivan RD, Norcross JW, Watkins E, Jr (1964) Chemotherapy of metastatic liver cancer by prolonged hepatic-artery infusion. N Engl J Med 270: 321
Watkins EJr, Khazei AM, Nahra KS (1970) Surgical basis for arterial infusion chemotherapy of disseminated carcinoma of the liver. Surg Gynecol Obstet 130: 581
Wiess GR, Garnick MB, Osteen RT, Steele GD, Jr, Wilson RE, Schade D, Kaplan WD, Boxt LM, Kandarpa K, Mayer RJ, Frei ET III (1983) Long-term hepatic arterial infusion of 5-fluorodeoxyuridine for liver metastases using an implantable infusion pump. J Clin Oncol 1: 337
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© 1986 Springer-Verlag Berlin · Heidelberg
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Balch, C.M., Urist, M.M. (1986). Intraarterial Chemotherapy for Colorectal Liver Metastases and Hepatomas Using a Totally Implantable Drug Infusion Pump. In: Herfarth, C., Schlag, P., Hohenberger, P. (eds) Therapeutic Strategies in Primary and Metastatic Liver Cancer. Recent Results in Cancer Research, vol 100. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-82635-1_30
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DOI: https://doi.org/10.1007/978-3-642-82635-1_30
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