Construction and evaluation of prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华普通外科杂志

Objectives@#To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.@*Methods@#The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis. A prognostic predictive nomogram was constructed and internally validated.@*Results@#115 patients were included. The median overall survival was 13.1 months, and 1-, 2-, 3-, and 5-year survival rates being 56.5%, 25.3%, 12.6%, and 8.1% respectively. Univariate and the following multivariate analysis identified completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival. The nomogram using these three factors showed a concordance index of 0.721 (95% CI: 0.669-0.773). The calibration curves for 1-, 2- and 3 -year survival probability showed a good consistency between actual observation and prediction.@*Conclusions@#The nomogram based on completeness of cytoreduction, temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

Construction and evaluation of prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy / 中华普通外科杂志

Objectives To construct a prognosis predictive nomogram for gastric cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.Methods The clinical data and follow-up results of gastric cancer with peritoneal carcinomatosis patients treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at our center from 2005 to 2017 were collected for log-rank test and multivariate COX proportional regression model analysis.A prognostic predictive nomogram was constructed and internally validated.Results 115 patients were included.The median overall survival was 13.1 months,and 1-,2-,3-,and 5-year survival rates being 56.5％,25.3％,12.6％,and 8.1％ respectively.Univariate and the following multivariate analysis identified completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy as independent prognostic factors on overall survival.The nomogram using these three factors showed a concordance index of 0.721 (95％ CI:0.669-0.773).The calibration curves for 1-,2-and 3-year survival probability showed a good consistency between actual observation and prediction.Conclusions The nomogram based on completeness of cytoreduction,temperature of hyperthermic intraperitoneal chemotherapy and type of adjuvant chemotherapy can effectively predict the survival probability for gastric cancer with peritoneal carcinomatosis patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

Combined Therapy involving Hepatic Arterial Chemoinfusion through a Percutaneously Implanted Port, and External Irradiation for Advanced Hepatocellular Carcinoma

PURPOSE: To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. MATERIALS AND METHODS: Fifteen patients (12 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a Chemoport(R); was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month. Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. RESULTS: The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). CONCLUSION: In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a Chemoport(R) and external irradiation achieved favorable results. Further controlled studies aimed at evaluating the prognostic factors involved are, however, required.

In vivo Pharmacokinetics of Adriamycin after Hepatic Arterial Chemo-Embolization with Adriamycin-Lipiodol Emulsion

PURPOSE: To analyse the parameters of in vivo pharmacokinetics such as absorption, distributionin , and excretion of adriamycin patients with hepatocellular carcinoma, and investigate the stagnation of adriamycin, in the liver. MATERIALS AND METHODS: Five patients in whom hepatocellular carcinoma was diagnosed and who were admitted for transhepatic chemoembolization were involved in this study. Fifty mg of adriamycin was mixed with 2.5 mL of water-soluble contrast material and 12 -15 mL of lipiodol, and the emulsion was injected into a selected tumor-supplying artery using a 3-F catheter. Between 1 minute and 72 hours after chemoembolization, peripheral blood samples were then obtained, and from these the blood concentration curve of adriamycin was calculated and applied to a two-compartment model. Using the model, several pharmacokinetic parameters were estimated. RESULTS: The volume of the central and the peripheral compartment was 45 L and 4090.6 L, respectively. 75.14% of adriamycin was delivered to the liver directly, and the absorption rate constant was 2.448/hr. Distribution clearance was 969.3 L/hr, and excretion and metabolic clearance was 136.4 L/hr. CONCLUSION: Using a two-compartment model, the in vivo pharmacokinetics of adriamycin after hepatic arterial chemoembolization were successfully analyzed. On the basis of the parameters determined, it may be concluded that in these five patients, adriamycin remained in the liver in much greater quantities and for longer. Index words : Liver neoplasms Liver neoplasms, chemotherapeutic embolization Chemotherapy, regional

The Effects of Low Dose Chemotherapy for Advanced Hepatocellular Carcinoma Through Percutaneously Implanted Intra-arterial Port System

PURPOSE: To investigate the effects of low-dose FP (5-Fluorouracil[5FU]+Cispatin[CDDP]) therapy through a percutaneously implanted intra-arterial port system in patients with advanced hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Twenty-five patients with advanced HCCs and portal vein thrombosis, or large HCCs which were unresectable or for which transarterial chemoembolization was thought to be ineffective, underwent intra-arterial port implantation. The mean maxinal diameter of these tumors was 13.7 (range, 5-21.5) cm, and they were located at the right lobe (n=18), the left lobe (n=3), or throughout the liver (n=4). Tumor thrombosis was detected in the main (n=14), right (n=3) and left portal vein(n=1), the right portal vein and inferior vena cava(n=2), and the inferior vena cava(n=1). The four others patients had no portal vein thrombosis. All intra-arterial port implantations were performed percutaneously in the angiographic ward through the right or left common femoral artery. The port chamber was implanted in the inguinal area and fixed using histoacryl. For intra-arterial chemotherapy, 5-FU (250 mg/day) and CDDP (10 mg/day) were used for five days every four weeks. In order to observe changes in tumor size, follow-up CT scanning was performed every two months. RESULTS: Implantation of the port system was successful in all cases, and patients underwent between one and eleven (mean, 3.9) sessions of chemotherapy. Port and catheter-related complications, namely dislodgement of the catheter(n=2), wound infection(n=2), migration of the coil(n=1) and catheter occlusion(n=1) occurred in six patients (24%), and chemotherapy-related complications, namely liver failure(n=3) and gastric ulcer bleeding(n=1), in four (16%). A complete response, i.e. the disappearance of tumor thrombosis of the portal vein, was achieved in one patient (4%), a partial response in three (12%), and a minor response in four (16%); the overall response rate was 32% and the mean survival period was 7.6 months. CONCLUSION: Low-dose FP therapy through a percutaneous intra-arterial port system may be one way of effectively treating advanced HCC patients who cannot undergo surgery or effective trans-arterial chemoembolization.

Percutaneous implantation of intra-arterial port system for regional drug infusion: Results and complications in 110 cases

PURPOSE: To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. MATERIALS AND METHODS: For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocelluar carcinoma (n = 79), liver metastasis (n = 16), gallbladder cancer (n = 4), stomach cancer (n = 3), pancreatic cancer (n = 3), Burger's disease (n = 2), diabetes mellitus (n = 2), or lymphoma (n = 1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n = 98), left subclavian artery (n = 10), or left superficial femoral artery (n = 2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) RESULTS: The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n = 34), proper hepatic artery (n = 49), right hepatic artery (n = 8), left hepatic artery (n = 1), descending aorta at T9 level (n = 10), left popliteal artery (n = 2), right external iliac artery (n = 1), left external iliac artery (n = 1), or left deep femoral artery (n = 1). Complications were encountered in 24 patients(22.4%), namely chamber site infection (n = 7), catheter dislodgement (n = 7), catheter occlusion (n = 3), migration of coil (n = 2), disconnection between chamber and catheter (n = 1), kinking of catheter (n = 1), arterial occlusion (n = 1), necrosis of overlying skin (n = 1), and leakage around port chamber (n = 1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. CONCLUSION: Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method may be useful for regional drug infusion in various