scholarly journals Electrostatic precipitation Pressurized IntraPeritoneal Aerosol Chemotherapy (ePIPAC): first in-human application

2016 ◽  
Vol 1 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Marc Reymond ◽  
Cedric Demtroeder ◽  
Wiebke Solass ◽  
Guido Winnekendonk ◽  
Clemens Tempfer
Keyword(s):  
Systemic Chemotherapy ◽  
Tumor Regression ◽  
Unknown Origin ◽  
Preclinical Model ◽  
Intraoperative Complication ◽  
Secondary Resection ◽  
Delivery Technique ◽  
Radiological Response ◽  
Ductal Pancreatic Cancer ◽  
Palliative Systemic Chemotherapy

AbstractBackground: Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug delivery technique with superior pharmacological properties for treating peritoneal metastasis (PM). Adding electrostatic loading (ePIPAC) as an adjunct to aerosol and artificial hydrostatic pressure improved tissue uptake in a preclinical model.Methods: We report the first ePIPAC use in 3 patients with PM of hepatobiliary-pancreatic (HBP) origin. All 3 patients received concomitant palliative systemic chemotherapy that was discontinued in two patients. PIPAC with cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 was applied intraperitoneally at a pressure of 12 mmHg and a temperature of 37% °C for 30 min. Additionally, a voltage 7,500–9,500 V and a current≤10 µA were applied over a stainless steel brush electrode emitting a stream of electrons.Results: ePIPAC was technically feasible. No intraoperative complication was noted. The procedures were well tolerated with no adverse event CTCAE > 2. Patient 1 with PM of unknown origin (CUP with HBP phenotype) showed an objective histological and radiological response and survived 11 months. Patient 2 with ductal pancreatic cancer underwent secondary resection after ePIPAC with no residual PM; however, tumor recurred 5 months later. Patient 3 with adenocarcinoma of the gallbladder showed a radiological regression of liver infiltration and is alive after 22 months without histological evidence of PM.Conclusion: ePIPAC is technically feasible, is well tolerated and can induce tumor regression of PM in HBP cancers with and without concomitant systemic chemotherapy. These preliminary results justify prospective clinical studies with ePIPAC.

FA06.01: CLINICAL EFFECT OF NEOADJUVANT CHEMOTHERAPY OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA FOR SUPERFICIAL PHARYNGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 11-11
Author(s):  
Hiroki Ishida ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Median Duration ◽  
Systemic Chemotherapy ◽  
Tumor Regression ◽  
Flat Type ◽  
Pharyngeal Squamous Cell Carcinoma

Abstract Background Esophageal squamous cell carcinoma (ESCC) is often synchronously accompanied by pharyngeal squamous cell carcinoma (PSCC). However, the treatment strategies for these cancers have not been established. Neoadjuvant chemotherapy is the standard treatment for advanced ESCC and is also effective for PSCC patients. However, few studies have focused on the efficacy of systemic chemotherapy for patients with superficial PSCC. Methods We retrospectively examined 22 cases of superficial PSCC that occurred in 14 patients with ESCC who received neoadjuvant therapy between January 2011 and June 2017. Results Of the 14 patients, 13 (93%) were male, and the median age was 63.5 years (range: 35–74 years). The clinical stage of ESCC was II for 7, III for 5, and IVB for 2 (AJCC 8th staging system). The PSCC origin included the oropharynx in 9 lesions (40.9%) and the hypopharynx in 13 lesions (59.1%). Macroscopic type was classified as protruding (type1 or 0-I) for 2, superficial elevated (0-IIa) for 5, superficial flat (0-IIb) for 13, and superficial depressed (0-IIc) for 2. The estimated depth of invasion was EP in 12 lesions, SEP in 8 lesions, and MP in 2 lesions. FP regimen was administered to 11 patients in 15 lesions and DCF to 3 patients in 7 lesions. One patient had concurrent chemoradiotherapy. Chemotherapy for PSCC resulted in CR in 10 lesions (45.4%). In CR, 9 of 10 lesions were of superficial flat type. All non-CR lesions also had tumor regression. In the CR patients, 5 lesions(50%) had local recurrence, and the median duration until recurrence was 4 months (range: 4 to 17 months). Endoscopic resection(ER) for PSCC was performed in the 13 lesions after esophagectomy. The median duration after diagnosis was 7 months (range: 3 to 20 months). Conclusion Systemic chemotherapy of ESCC has tumor regression potential for superficial flat-type PSCC with clinical tumor invasion in EP or SEP. Although chemotherapy for PSCC results in non-CR, additional ER is quite effective. Because half of the CR lesions had recurrence, strict follow-up and observation of the pharynx are reasonable options for patients with ESCC. Disclosure All authors have declared no conflicts of interest.

Comparison of outpatient parenteral nutrition regimens of patients with GIT tumors with and without receiving simultaneous palliative systemic chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18578-18578
Author(s):  
P. Stuebs ◽  
J. Fahlke ◽  
C. Schmidt ◽  
P. Habermann ◽  
A. Hribaschek ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Parenteral Nutrition ◽  
Total Protein ◽  
Systemic Chemotherapy ◽  
Impedance Analysis ◽  
Ambulatory Care Setting ◽  
Bioelectric Impedance Analysis ◽  
Laboratory Values ◽  
Palliative Systemic Chemotherapy ◽  
At Home

18578 Background: The nutritional status of oncology patients significantly impacts the success of tumor-specific therapy.This study was designed to objectify the benefit of parenteral nutrition therapy (PN) administered in the ambulatory care setting and at home by evaluation of nutritional parameters in patients simultaneously undergoing palliative systemic chemotherapy. Methods: From 2003 through 2005 56 patients diagnosed with metastatic GIT tumors were included in the survey.43 patients received PN at home (hPN n=16) or in the ambulatory clinic (aPN n= 27) over a period of 8 weeks because of their poor nutritional status.Of 36 patients who underwent palliative systemic chemotherapy, 25 received PN (13 hPN/12 aPN).In aPN 600kcl were administered, while 1500 kcal where given in hPN.The therapy was administered 5 times a week.In all patients albumin and total protein were measured weekly along with body composition via bioelectric impedance analysis (BIA). Results: Over the course of 8 weeks a continuous decrease of albumin and total protein was found in patients not receiving PN.In aPN laboratory values decreased during the first 4 weeks and later stabilized at low levels.In hPN continuous increases in albumin and total protein were observed.BIA results were comparable.In patients receiving chemotherapy without PN there was an initial improvement of relevant BIA parameters followed by a noticeable decline, while in patients receiving chemotherapy and simultaneous PN a stabilization of values occurred after a slight initial decrease.Evaluation of the corresponding laboratory values showed no decline in the group receiving PN but a significant decline in patients receiving chemotherapy only. Conclusions: The nutritional status of patients with GIT tumors shows a continuous decline during chemotherapy without the addition of PN.This study’s data indicate an advantage of PN for patients with GIT tumors, when started early enough. When chemotherapy and PN are administered, there are limitations the use of BIA as a method of measurement.Verification of laboratory parameters specific to nutrition in the process of treatment is both adequate and necessary for assessment of nutritional status. No significant financial relationships to disclose.

Histological tumor regression after preoperative chemotherapy for colorectal liver metastases: Correlations with radiological response and prognosis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 609-609
Author(s):  
Ryo Inada ◽  
Shigeyoshi Iwamoto ◽  
Masaki Kaibori ◽  
Morihiko Ishizaki ◽  
Hiroya Iida ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Tumor Regression ◽  
Molecular Target ◽  
Tumor Regression Grade ◽  
Major Response ◽  
Radiological Response ◽  
Regression Grade

609 Background: The purpose of this study was to characterize histological tumor regression grade (TRG) to colorectal liver metastases (CLM) treated with preoperative chemotherapy followed by liver surgery, and to evaluate whether TRG correlates with radiological response and prognosis. Methods: This study included 30 patients with CLM treated by surgical resection after preoperative chemotherapy with oxaliplatin- or irrinotecan-based regimens with or without molecular target agents. TRG was determined by the amount of fibrosis and necrosis replaced from tumor cells, ranging TRG 0 (0%), 1 (1-24%), 2 (25-50%), 3 (51-99%), and 4 (100%). Results: TRG 0, 1, 2, 3, and 4 were observed in 0%, 6.7%, 10.0%, 66.7%, and 16.6% of the patients, respectively. There were no relations between TRG and regimen, including molecular target agents. As shown in the table, radiological response was not significantly correlated with TRG. Patients with histological major response (TRG 3+4) had better prognosis (MST; TRG 1+2 vs. 3+4: 20.0 vs. 50 months, P= 0.007), and a multivariate analysis identified histological major response as an independent good prognostic factor. Conclusions: In this analysis, histological TRG predicted survival after preoperative chemotherapy and resection for CLM. Preoperative radiological response could not evaluate TRG. [Table: see text]

Downstaging of unresectable intrahepatic or hilar cholangiocellular carcinoma by selective intra-arterial floxuridine and systemic cisplatin and gemcitabine. A dose finding single center phase IIa study.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 478-478 ◽  
Author(s):  
Heike Pietge
Keyword(s):  
Systemic Chemotherapy ◽  
Hepatic Arterial Infusion ◽  
Progression Free Survival ◽  
Response Rates ◽  
Maximum Tolerated Dose ◽  
Dose Finding ◽  
Fixed Dose ◽  
Pet Ct ◽  
Tract Infections ◽  
Palliative Systemic Chemotherapy

478 Background: Patients with unresectable cholangiocarcinomas (CCC) have a poor prognosis even if palliative systemic chemotherapy is offered. A combined approach of systemic and intrahepatic chemotherapy may improve local control rates and allow downstaging. The aim of the study was to determine the maximum tolerated dose (MTD) of systemic intravenous gemcitabine in combination with intravenous cisplatin and hepatic arterial infusion with floxuridine in patients with unresectable intrahepatic or hilar CCC. Safety, toxicity, response rates and resectability rates after 3 months of combination treatment are reported. Methods: 12 patients were treated within a 3+3 dose escalation algorithm with 600, 800 or 1000 mg/m2 gemcitabine and a fixed dose of cisplatin 25 mg/m2 systemic chemotherapy on day 1, 8 every 3 weeks for 4 cycles and floxuridine 0,2 mg/kg on day 1-14 continous hepatic intra-arterial chemotherapy every 4 weeks for 3 cycles. PET/CT and/or CT scan was performed after 12 weeks. Results: The MTD of gemcitabine was 800 mg/m2 in this setting. Dose-limiting toxicities were recurrent biliary tract infections (n = 1) and neutropenic fever (n = 1). Response rates were: 27% partial remission and 73% stable disease. Although none of the patients achieved resectability after 3 months, 3-year-overall survival (OS) was 33%, median OS 21,9 months (1-49) and median progression-free survival 10,5 months (2-40). Conclusions: Combination of systemic gemcitabine and cisplatin plus intraarterial floxuridine is feasible and appears effective in disease control, but achievement of resectability seems challenging. Randomized trials comparing this combination to gemcitabine/cisplatin alone are warranted. Clinical trial information: NCT01692704.

Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program.

1992 ◽  
Vol 10 (12) ◽  
pp. 1933-1942 ◽  
Author(s):  
L Leichman ◽  
H Silberman ◽  
C G Leichman ◽  
C P Spears ◽  
M Ray ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Trial ◽  
Systemic Chemotherapy ◽  
Tumor Regression ◽  
Neoadjuvant Treatment ◽  
Tumor Resection ◽  
Sodium Thiosulfate ◽  
Treatment Phase ◽  
Gastric Tumor ◽  
Neoadjuvant Systemic Therapy

PURPOSE A clinical trial for patients with gastric cancer amenable to curative resection was undertaken to determine feasibility and response to preoperative systemic chemotherapy followed by postoperative intraperitoneal (IP) chemotherapy. METHODS AND MATERIALS Thirty-eight patients with resectable gastric tumor received two cycles of protracted intravenous (IV)-infusion fluorouracil (5FU), 200 mg/m2/d, for 3 weeks with weekly IV leucovorin 20 mg/m2 and IV cisplatin 100 mg/m2 days 1 and 29. Resection of the gastric tumor followed within 3 weeks of completion of systemic chemotherapy. Those who had all visible tumor removed with clear margins received two cycles of IP floxuridine 3,000 mg (total dose) per day for 3 days and IP cisplatin 200 mg/m2 with IV sodium thiosulfate on the fourth day of IP therapy. RESULTS Thirty-seven of 38 patients (97%) received two cycles of systemic chemotherapy. Thirty-five of 38 patients (92%) underwent laparotomy for gastric tumor resection. Thirty-three patients (87%) had gastric resections performed; 29 (76%) had all visible tumor removed with microscopically negative margins. No operative mortality was encountered. Twenty-six patients (68%) received IP treatment. IV neoadjuvant treatment was well tolerated and resulted in 68% of the patients reporting improvement in abdominal pain, 45% objective remissions by computed tomography (CT), 38% objective remissions by gastroscopy and biopsy, and 8% had complete surgical pathologic response. Neutropenic sepsis during the IP treatment phase contributed to the only treatment-related death. Four of 29 completely resected patients (14%) have had tumor recurrence. The median follow-up time of patients remaining alive is now 19 months. The median survival for 38 patients entered onto this protocol has not been reached at 17+ months. CONCLUSION This novel approach to the treatment of adenocarcinoma of the stomach is feasible. The neoadjuvant systemic therapy results in significant primary tumor regression. The determination of whether systemic or IP components of the program contribute to decreased recurrence or increased survival awaits a prospectively randomized clinical trial.

Sign in / Sign up

Export Citation Format

Share Document