Search

Purpose. Determine the nature of tumor regression and possible complications associated with the retinotoxic effect of melphalan and carboplatin with local chemotherapy.Methods. A histological analysis of 19 enucleated eyes from 19 patients with retinoblastoma was performed after combined organ-preserving treatment, including systemic chemotherapy and local chemotherapy in various doses. The enucleated eyes were fixed in 10 % formalin and processed routinely for histological examination.Results. Significant changes in the tumor tissue such as tumor regression associated with the destruction of the tumor tissue and its replacement with fibrous tissue, glia proliferation, and the formation of petrificates were revealed. Complete regression of the tumor was detected in 3 out of 19 eyes, partial in 13 eyes. There were no signs of regression in 3 eyes. Tumor invasion into the choroid was found in 5 cases, into the anterior sector — in 3 cases, into the optic nerve — in 3 cases. The retrobulbar tumor was presented in 1 case. Retinotoxic complications revealed. Hemorrhagic changes associated with focal necrosis of the central retinal vessels (n = 4), destructive changes in retinal pigment epithelium (RPE; n = 10) associated with the accumulation of melphalan in RPE leading to atrophic processes in the retina. Complications in the form of secondary glaucoma, severe fibrosis and retinal detachment, despite the complete resorption of the tumor, led not only to loss of vision, but also hindered visualization of the fundus and substantiated the need for enucleation in 3 cases. In other cases, enucleation was performed due to continued tumor growth (n = 16) or progression during treatment (n = 3).Conclusions. Retinoblastoma can be controlled with local chemotherapy. However, clinical and morphological examinations of enucleated eyes revealed and confirmed, along with tumor resorption, intraocular complications as a result of the toxic effect of the drugs and the presence of active tumor tissue to varying degrees of therapeutic pathomorphism, which can be explained by the resistance of RB to these drugs. Thus, a further search is needed for drugs that destroy the tumor and minimize the retinotoxic effect.

Retinoblastoma eyes with choroidal invasion may not have to be enucleated and may be successfully managed with OAC using Melphalan, Carboplatin and Topotecan without compromising patient survival.

The study objective is to evaluate the results of organ-preserving treatment of locally advanced larynx squamous cell carcinoma.Materials and methods. Analysis of 28 patients with locally advanced larynx squamous cell carcinoma (stages III-IV) who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia between 2017 and 2020 was performed. At the first stage, 2-3 courses of combined inductive polychemotherapy per the DCF scheme with 21-day interval were performed (docetaxel 60 mg/m2, cisplatin 60 mg/m2 intraarterially bolus with detoxication with sodium thiosulfate, 5-fluorouracil 1000 mg/m2/day as 96-hour infusion). The second stage included external beam radiotherapy (60-70 Gy, 2 Gy per day 5 days a week) as monotreatment if complete clinical response after chemotherapy was achieved or with regional administration of cisplatin (60 mg/m2 once per 3 weeks) if after inductive stage full clinical response wasn»t observed.Results. In 20 (71.5 %) patients, complete clinical response was observed after inductive treatment; in 7 (25 %) patients, partial response was observed. Tumor stabilization was detected in 1 (3.5 %) patient. Two-year overall survival was 95.8 ± 4.1 %, progression-free survival was 90.1 ± 6.8 %.Conclusion. The proposed strategy of organ-preserving treatment of stage III-IV larynx cancer with substitution of systemic chemotherapy with regional intraarterial chemotherapy prior to radiotherapy is highly effective from the point of view of direct anti-tumor effect and recurrence-free and overall survival.

Background The aim of this study was to evaluate the long-term treatment results of combined superselective intraarterial chemotherapy and radiation therapy for advanced maxillary sinus cancer (MSC) and the incidence of regional lymph node failure, and to reveal the clinical and anatomical predictive factors for metastasis. Methods We retrospectively evaluated 55 consecutive patients with locally advanced squamous cell carcinoma of the maxillary sinus who were treated with external radiotherapy and superselective intraarterial chemotherapy. Elective nodal irradiation (ENI) was performed only in the clinical node-positive (cN+) cases and not in the clinical node-negative (cN0) cases. Results: Thirty-eight patients were cN0, and 17 were cN+ at diagnosis. Regional lymph node metastases occurred in 7 of 38 patients with cN0, and 2 of 17 with cN+ during the median follow-up period of 36 months. There were more cases of high-grade (3 or 4) late adverse events in the ENI group than in the non-ENI group (13% vs. 41%, respectively; p = 0.03). In cN0 cases without ENI, invasion of the pterygoid plates (57% vs. 90%; p p = 0.02) was significantly correlated with a low 5-year regional recurrence-free rate. Conclusions Patients with MCS and invasion of the pterygoid plates and oral cavity can be considered appropriate candidates for ENI.

Aim. To estimate the effectiveness of intraarterial chemotherapy in treatment of patients with unresectable colorectal liver metastases resistant to systemic chemotherapy. Materials and methods. Between 2011 and 2018, 64 patients were treated. Previously performed 3–35 cycles of systemic chemotherapy was assessed as ineffective in 58 and discontinued in 6 patients because of grade III–IV toxicity. The most effective cytostatics previously used in systemic chemotherapy was used for intraarterial therapy. In the absence of effective drugs, monotherapy with Mitomycin C was done. For hypovascular metastases hepatic arterial infusion was performed using 4–6 g 5-fluorouracil, 15–20 mg Mitomycin C, 150–200 mg Oxaliplatin or 160–200 mg Irinotecan per cycle. For hypervascular metastases was used oily chemoembolization included selective infusion of suspension consisted of Lipiodol with Mitomycin C 10–20 mg or Irinotecan 160–200 mg or Doxorubicin 50–80 mg followed by occlusion of feeding arteries with gelfoam. Combination TACE + HAI was performed in anatomical variants of hepatic artery. Results. We performed 238 cycles of intraarterial chemotherapy (from 2 to 16, average 3,7 per patient). There were no major complications and mortality. Progression-free survival after the intraarterial chemotherapy was 11.7 months. The median survival from the start of first cycle of systemic chemotherapy was 22 mo. in group patients with synchronous and 23 mo. with metachronous metastases. Conclusion . Preliminary results show promising intraarterial chemotherapy for treatment of patients with chemoresistant colorectal liver metastases. The application of the method makes it possible to reduced tumor growth for one year after interruption of systemic chemotherapy.

Background. The goal of treatment of retinoblastoma is not only the preservation of life and vision, but also the minimization of systemic complications, a cosmetic defect, which is achieved through the development of selective intraarterial chemotherapy (SIACT). Repeated conduction of the SIACT at the time of catheterization a. ophtalmica is accompanied by cardio-respiratory disorders (CRD). Objectives. We analyze the effectiveness and safety of retrobulbar blockade with a 0.,5 % solution of ropivacaine to prevent or reduce CRD. Materials and methods. The study included patients from the Blokhin National Medical Research Center of Oncology with retinoblastoma under conditions of general anesthesia in 2017–2018 SIACT procedures were performed (n = 267). 83 patients were primary. 83 % of them had a mild and moderate degree of cardio-respiratory disorders during the second SIAHT procedure, 17 % of patients who were included in the study developed marked CRD (n = 14), for the prevention of which, during the third procedure of SIACT was performed retrobulbar blockade (RBB). Results. 4 (28.57 %) patients after retrobulbar blockade did not develop CRD in the third SIACT procedure, in 5 (35.7 %) patients after performing RBB, CRD symptoms decreased to moderate and in 5 (35.7 %) mild expressiveness. After the RBB, there was a lesser increase in airway resistance during inhalation of Pinsp 25.4 ± 7.4, versus 33.8 ± 3.2 with OA and more stable hemodynamics. When conducting retrobulbar blockade with a solution of ropivacaine 0.5 % with a volume of up to 1.5 ml, no complications were observed in children with retinoblastoma. Conclusion. In our experience, pronounced cardio-respiratory complications are often observed during repeated sessions of SIACТ in children with retinoblastoma and can be potentially life-threatening. Using of retrobulbar blockade with severe CRD may reduce the frequency and degree of development of respiratory disorders and is accompanied by greater hemodynamic stability.

We report two pediatric retinoblastoma patients with unusual ophthalmic artery (OA) origins who were referred to our interventional neuroradiology department for intraarterial chemotherapy. The first patient had double OAs arising from the ipsilateral internal carotid artery and a central retinal artery (CRA) arising from the more cranially located artery, whereas the second patient had an OA originating from the A1 segment of the ipsilateral anterior cerebral artery. In both cases the CRA arose from the artery entering the orbit through the optic foramen. Both patients tolerated the procedures well. To the best of our knowledge, our retinoblastoma patients with unusual OA origins are the first in the literature in which detailed knowledge of the orbital vasculature and especially CRA origin carried immediate clinical implications, altering access strategies. These variations were proved both by flat-panel detector computed tomography findings and superselective injections of OAs with unusual origins. Our results show that in patients with retinoblastoma, a detailed angiographic work-up may be necessary to evaluate the orbital vasculature and possible abnormal origin of the OA. Recognition of possible variations of OA origin and its branching patterns is of the utmost importance for successful treatment and avoidance of adverse events among retinoblastoma patients.

To overcome drug resistance in relapsed ovarian cancer, an isolated perfusion system was used to generate a higher local exposure to cytostatic drugs. In addition to cisplatin as the cytostatic agent of choice, the present study combined adriamycin and mitomycin in a three drugs regime due to their increased cytotoxicity under hypoxia. A total of 107 patients, including 87 patients with relapses after previous platinum-containing therapies, 46 stage IIIC and 41 stage IV cases, were enrolled in the present study. A total of 25 patients were chemonaive, including 20 stage IIIC. The systemically pretreated patients in stage IIIC survived a median of 12.8 months, and those in stage IV 10.9 months. The overall clinical response rate of stages IIIC and IV combined was 69%. A complete decrease in ascites was found in 43% of all patients, a significant reduction in 19%. Toxicity and side effects were very mild and the bone marrow suppression was mostly grade I and never exceeded grade II. The primary clinical symptom in patients with post-therapeutic tumor necrosis, which occurred in 10-15% of all cases, was fever, fatigue and poor performance. The isolated hypoxic abdominal perfusion treatment is a potent instrument to break an existing chemoresistance without significant side effects with a good quality of life and comparatively long survival time.

To evaluate the feasibility and safety of percutaneously implanted arterial port catheter systems for hepatic arterial infusion of chemotherapy (HAI) in patients with unresectable liver malignancies. From October 2010 to August 2018, arterial port catheters for HAI were percutaneously implanted in 43 patients with unresectable liver malignancies. Three different catheter placement techniques were compared: a conventional end-hole catheter placed in the common hepatic artery (technique 1, n = 16), a side-hole catheter with the tip fixed in the gastroduodenal artery (technique 2, n = 18), and a long-tapered side-hole catheter with the tip inserted distally in a segmental hepatic artery (technique 3, n = 6). Catheter implantation was successful in 40 (93%) of the 43 patients. Complications related to catheter placement were observed in 10 (23%) patients; 5 (83%) of the 6 major complications were resolved, as well as all 4 minor complications. Catheter migration and occlusion occurred in 9 (22.5%) patients. Catheter migration was more frequent with technique 1 (n = 6) than with technique 2 (n = 1), although the difference was not significant (p = 0.066). Percutaneous arterial port catheter implantation for HAI is highly feasible and carries a low risk of complications.

Retinoblastoma (RB) is the most common intraocular malignancy of in childhood. Approximately 60% of cases are unilateral while 40% are bilateral...

Colorectal cancer (CRC) is one of the leading cancers globally in terms of both incidence and cancer-related mortality. Liver metastatic disease is the main prognostic driver for patients with CRC. The management options for liver metastatic CRC continue to evolve, particularly with the incorporation of locoregional therapies into the treatment paradigm. Hepatic arterial infusion (HAI) chemotherapy is one such liver directed approach used with the goal of converting patients to liver resection, reducing the risk of recurrence, treating recurrent disease, and most importantly improving overall survival. This article summarizes the role of HAI chemotherapy in the treatment of liver metastatic CRC.

Experience of neoadjuvant selective intraarterial chemotherapy in accordance to FOLFIRINOX scheme, conducted in a patient, suffering a conditionally resectable cancer of the right anatomo-surgical segment of pancreatic gland

INTRODUCTION AND OBJECTIVE:Introduction: Neoadjuvant chemotherapy showed survival benefit in randomized trials and meta-analyses. Adjuvant chemotherapy after radical cystectomy for patients with pT...

We report the case of a 9-month-old girl with bilateral retinoblastoma who had incomplete tumor resolution after selective ophthalmic artery infusion chemotherapy (SOAIC). Systemic chemotherapy, rarely used as salvage therapy after SOAIC, with systemic carboplatin, etoposide, and vincristine achieved complete and sustained regression in both eyes.

Background Ophthalmic artery chemosurgery [OAC, intra-arterial chemotherapy (IAC)] was introduced in 2006 as treatment modality for intraocular retinoblastoma. The purpose of this commentary is to retrospectively review the incidence of metastatic deaths in retinoblastoma patients treated with OAC worldwide over a 10 year period. Retrospective data regarding metastatic deaths was collected from six international retinoblastoma centers (New York City USA, Philadelphia USA, Sao Paulo Brazil, Siena Italy, Lausanne Switzerland and Buenos Aires Argentina). All retinoblastoma patients from these centers (naive and recurrent, unilateral and bilateral) treated with OAC/IAC since 2006 have been included in this study. Data regarding number of patients, number of OAC/IAC infusions, number unilateral and bilateral, number treated for naive disease or salvage and number of metastatic deaths have been assessed. Over a 10-year period of time 1139 patients received OAC/IAC for 4396 infusions. At last follow-up there were only three metastatic deaths (all treated in Buenos Aires). Conclusion The current survey assessed the recorded risk of metastatic deaths in six retinoblastoma centers worldwide in children with retinoblastoma (unilateral or bilateral) treated with OAC/IAC as primary or secondary therapy. Overall, the observed risk for metastatic deaths from retinoblastoma was

BACKGROUND Primary central nervous system lymphomas (PCNSL) are considered a rare and aggressive form of central nervous system (CNS) tumors. High-dose methotrexate has become the backbone of PCNSL treatment, and is recommended by the EANO guidelines. In most recent protocols, investigators tend to postpone or even avoid the use of radiotherapy; indeed, its use has become controversial with findings of associated severe neuro-toxicity, especially in elderly patients. To maximize delivery across the BBB, we use cerebral intra-arterial chemotherapy (CIAC) coupled with osmotic blood-brain barrier disruption (OBBBD). We hereby report our single-center experience over 18 years with the CIAC + BBBD technique using 2 different HD-MTX protocols. MATERIAL AND METHODS This phase II study was conducted at the Centre hospitalier Universitaire de Sherbrooke (CHUS) from November 1999 to May 2018. The protocol was approved by the institutional review board, and informed consent was obtained in accordance to institutional regulation in every patient After enrollment and initial evaluation, patients were treated every four weeks (1 cycle) for 12 cycles, unless progression. After general anesthesia, a transfemoral approach was used to catheterize either the right or left internal carotid artery or the dominant vertebral artery, depending on tumor(s) location. OBBBD was performed by infusing 20% mannitol in the selected vascular distribution for 30 seconds at a rate that fills the vascular distribution so as to maximize the contact of the mannitol with the endothelial cells.Two different chemotherapy regimens were sequentially used in this study. High-dose MTX (5 g IV) was the cornerstone of both regimens: the first regimen (1999 to 2007) also included etoposide phosphate IV (400 mg/m²) and cyclophosphamide IV (660 mg/m²), whereas the 2nd regimen (1998 to 2018) also included carboplatin IA (400 mg/m²). RESULTS The present analysis therefore concerns a cohort of 44 naive patients recruited over 18 years in a single center. Median follow-up was 38 months. Overall, a CR was induced in 34 patients (79%). Themedian time to CR was 7.3 months (IQR: 7.8). Of these 34 patients, 11 (25.6%) are still alive, and 9 of these are disease-free after treatment discontinuation. The actuarial median survival (MS) was 46.5 months (95% CI: 30.9–62.2) for the cohort. Survival was 88%, 64%, 54%, 39% and 18% at 1, 2, 3,5 and 10 years (Figure 1 and Table 2).The progression-free survival was 43.4 months (95% CI: 17.9–68.9). Five occurrences of vascular complications related to the treatment were observed (11.6%). Conclusion: CIAC HD-MTX-based protocols with OBBBD is a safe and well-tolerated procedure for the management of primary CNS lymphoma. Our single center data suggests better PFS and survival outcomes compared to IV protocols with less hematologic toxicity and good tolerability, especially in the elderly.

A method of care of patients with locally-advanced breast cancer consisting of using regional selective intraarterial chemotherapy in the schedule of the complex (palliative) treatment is presented. Results of treatment showed an advantage in comparison with the application of traditional methods of the breast cancer treatment. The methodology on intra-arterial introduction of chemotherapeutic agents developed at Donetsk Regional Antitumoral Center and University clinic of Odessa showed its undisputable contribution into development of modern oncology through decrease of primary tumoral locus, transition from inoperable state into the state at which it is possible to perform the radical volume of surgical interference to patient. The special attention is paid to development of new methods of treating BC patients (regional forms of disease) with unfavorable factors for forecast of tumor growth.

Purpose Intraarterial chemotherapy for retinoblastoma is usually reserved for infants aged 3 months or older because of the intricacy of the newborn vascular anatomy making the procedure technically challenging. The authors report a successful case of intraarterial chemotherapy performed in a 2-month-old infant using a minimal exposure approach. Methods Case report. Results A 2-month-old infant presented with leukocoria and was subsequently diagnosed with an exophytic Group D retinoblastoma in the right eye. The infant received melphalan 3 mg delivered into the ostium of the ophthalmic artery of the right eye under fluoroscopic guidance. Examination under anesthesia a month later showed complete tumor regression to a calcified Type I scar. After a second cycle of intraarterial chemotherapy, no further treatment was necessary. There were no complications. Conclusion Intraarterial chemotherapy is generally used for retinoblastoma in infants aged 3 months or older. The patient was successfully catheterized and treated at 2 months of age, with complete tumor regression after a single chemotherapy dose. Thus, in expert hands, intraarterial chemotherapy can be considered in such young infants.

Contemporary treatment of glioblastoma involves an optimal surgery, followed by a combination of radiation and temozolomide. The reported progression-free survival with this treatment is only 6.9 months. At recurrence, few therapeutic options are available given the paucity of chemotherapeutics crossing the blood-brain barrier (BBB). Cerebral Intra-arterial Chemotherapy (CIAC) in the treatment of gliomas allows to bypass the BBB and the brain-tumor barrier (BTB), but fell into oblivion after a major randomized study led by the BTCG showed no therapeutic advantages, and a major complication profile. Looking at the reasons for this failure, the choice of chemotherapeutics, concentration, volume and infusion rate, catheter placement can all be invoked. But nowadays, with refinements in angiographic hardware and technics, and the availability of new therapeutics, CIAC is ready to rise again. In this work, we present the largest series of glial tumors treated by CIAC to our knowledge. Over 15 years, 463 glial tumors comprising 319 GBM tumors were treated at the CHUS (centre Hospitalier Universitaire de Sherbrooke) with a standardized CIAC protocol of monthly carboplatin administration. All patients were treated at relapse. Seventeen percent were treated at first relapse, 68% at second relapse, 11% at third relapse and 4% at fourth. Overall, the patient received a median of 4 cycles (1 to 22 cycles). The whole series presented an overall median survival of 25 months, whereas survival from study entry was 8 months for the entire cohort. Ten patients are still alive, with the longest survival now at 12 years. The overall complication rate was 0.75%, with the most frequent occurrence being lacunar strokes. We believe that a better selection of patient, molecular subclassification, and the continued search for chemotherapeutics will improve these results. The procedure is safe, and should be considered an easy and viable delivery option to circumvent BBB.

Retinoblastoma is a deadly eye cancer in children, leading to death in 50%–70% of children in undeveloped nations. Unfortunately, this aggressive tumor is the most common intraocular malignancy worldwide. For the last 2 decades, intravenous (IV) chemotherapy has been the mainstay of treatment for retinoblastomas. This route has provided improved control in retinoblastoma, with sparing of the eye and vision in some cases. More recently, intra-arterial chemotherapy (IAC) has become the first line treatment for advanced and refractory retinoblastoma in many centers worldwide. The advances in treatment along with early tumor detection are responsible for the favorable prognosis found in developed nations. IAC classically uses the ophthalmic artery (OA) in attempt to deliver the maximal dose of chemotherapy while minimizing systemic complications. However, direct catheterization of the ophthalmic artery (OA) is not always possible. The purpose of this article is to describe a case where the OA has been thrombosed and an alternative access route using the middle meningeal artery (MMA) was used.

The prognosis of locally advanced or recurrent squamous cell carcinoma (SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregionally advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overall survival for the patients was 24 months (range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potentially curative in locoregionally advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

International audience; 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) allows to quantify the metabolic activity of a tumor (glycolysis) and has become a reference tool in oncology for the staging, restaging, radiotherapy planning and monitoring response in many cancers. Quantitative analyses have been introduced in order to overcome some of the limits of the visual methods, allowing an easier and more objective comparison of the inter- and intra-patients variations. The aims of this review were to report available evidences on the clinical value of quantitative PET/CT parameters in HNC. Forty-five studies, for a total of 2928 patients, were analyzed. Most of the data available dealt with the intensity of the metabolism, calculated from the Standard Uptake Value (SUV). Metabolic Tumor Volume (MTV) was well correlated with overall survival and disease free survival, with a higher predictive value than the maximum SUV. Spatial distribution of metabolism and textural analyses seems promising.

Retinoblastoma is a deadly eye cancer in children, leading to death in 50%–70% of children in undeveloped nations who are diagnosed with it. This malignancy is the most common intraocular tumor in childhood worldwide. The good prognosis in developed nations is related to early detection and advanced treatments. With the advent of intraarterial chemotherapy, neurosurgeons have taken a central role in the treatment of this pediatric condition. Intraarterial chemotherapy is a novel treatment for retinoblastoma whereby chemotherapeutic agents are precisely delivered into the ophthalmic artery, minimizing systemic toxicity. This procedure has shown impressive results and has allowed a dramatic decrease in the rate of enucleation (eye removal) in advanced and refractory retinoblastoma. Recent reports have raised some concerns about the risk of ocular vasculopathy, radiation-related toxicity, and the potential for metastatic disease after intraarterial chemotherapy. In the authors' experience of more than 3 years, tumor control is excellent with globe salvage at 67% and vascular events less than 5%, mostly related to improvement in technique. The role of this novel approach in the management of retinoblastoma has yet to be defined. As more centers are adopting the technique, the topic will decidedly become the focus of intensive future research. In this paper, the authors review and discuss current data regarding intraarterial chemotherapy for retinoblastoma.

Retinoblastomas are the most frequent primary malignant intraocular tumours worldwide. Conventional and new treatment modalities have significantly improved the chance for survival and preservation of vision. The armamentarium of treatment modalities has been broadened recently by new techniques like intraarterial chemotherapy, which still has to be considered as experimental since long-term follow-up results are not yet available. The excellent prognosis for retinoblastomas in countries with a well developed health system is contrasted by the miserable prognosis for retinoblastomas in developing countries, which must be changed by a joint effort of all centres.

Uveal melanoma (UM) is the most prevalent intraocular malignant tumor in the Western world. The prognosis of survival in the presence of metastatic disease is 2-7 months, depending on the treatment applied. This article presents a case of metastatic UM with successful complex treatment of liver metastases. A 49-year old female, underwent removal of the right eyeball in 1996 due to a histologically confirmed uveal melanoma. After 11 years, CT revealed a mass in the left kidney and multiple metastases in the liver. After left nephrectomy, 6 chemotherapy courses with dacarbazine were performed. The increasing liver metastases were observed. Additional 4 intraarterial (i/a) chemotherapy courses were administered using cisplatin, doxorubicin, fluorouracil, and interferon alfa. After few courses increase in CTC Grade 4 liver transaminases was seen. A partial response was observed, and in December 2008 the patient underwent surgery removing all liver metastases by 7 wedge or atypical resections. All margins were tumor-free. 21 months after liver resections and 14 years since diagnosis, the patient is alive without evidence of disease. Successful treatment of metastatic uveal melanoma was due to a timely application of a combination of several treatment methods and good prognostic factors of the patient.

Background: The feasibility and results of intraarterial chemotherapy, also termed ophthalmic artery chemosurgery (OAC), for retinoblastoma in less developed countries have seldom been reported. Procedure: A retrospective evaluation of a program of OAC in Argentina from 2010 to 2015. Results: Ninety-seven eyes from 81 patients (61 bilateral) were analyzed. In 35 eyes, OAC was given as primary therapy and in 62 it was used for the treatment of tumors with partial response or those relapsing after systemic chemoreduction with focal therapy or external-beam radiotherapy. Twenty-two primarily treated eyes had group D and 13 groups B/C. A total of 400 procedures were carried out. Chemotherapy used included combinations of melphalan, carboplatin, and topotecan. There was no mortality associated with OAC. Toxicity included fever and neutropenia in five (1.25%), hypotension and bradycardia during anesthesia in two and femoral thrombosis in one, eyelid edema in nine, and neutropenia or thrombocytopenia in 28 cycles. With a median follow-up of 48.7 months (range 12–79), the 3-year probability of event-free survival (pEFS) (enucleation and/or radiotherapy were considered events) was comparable for patients who received first-line therapy and those treated at relapse (0.65 vs. 0.63, P = 0.5). In the former, the pEFS was 0.91 and 0.43 for groups B/C and D, respectively (P = 0.01). Two patients died of extraocular dissemination after refusal of enucleation. Conclusions: OAC was feasible with low toxicity. pEFS improved in all groups compared to the previous experience with systemic chemotherapy reducing the use of radiotherapy. The overall mortality associated with OAC is comparable to our previous experience with systemic chemoreduction. Fil: Funes, Santiago. Hospital Universitario Austral; Argentina Fil: Sampor, Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Villasante, Francisco Eduardo. Hospital Universitario Austral; Argentina Fil: Fandiño, Adriana Cristina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Manzitti, Julio. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Sgroi, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Neira, Pablo. Clinica y Maternidad Suizo Argentina; Argentina Fil: Peralta, Laura. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Lagomarsino, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Schaiquevich, Paula Susana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Ceciliano, Alejandro. Hospital Universitario Austral; Argentina Fil: Chantada, Guillermo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Hospital Universitario Austral; Argentina

症例は54歳，男性．発熱，倦怠感を主訴として来院した．CTで脾膿瘍と多発性肝膿瘍と診断し抗菌剤全身療法を行ったが，発熱が持続した．脾動脈内にカテーテルを留置し，抗菌剤の動注療法を開始したところ，速やかに解熱し，CTでも膿瘍は消失した．以後，再発は認めていない．若干の文献的考察を含めて報告する．

Objective To clarify the effect of intraarterial chemotherapy on vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) count in carcinoma of the cervix.

Die intraarterielle Chemotherapie (i.a.CHT) mit hochdosiertem Cisplatin kombiniert mit systemischer Neutralisation bei Patienten mit Kopf-Hals-Tumoren (HNSCC) wird praoperativ zur Verkleinerung des Tumorvolumens eingesetzt. Ziel der Studie ist die Evaluierung des Einflusses der i.a.- CHT auf den Stoffwechsel vom Fluor-18-Desoxyglukose (FDG) des Primarius und der zervikalen Lymphknoten (LKs) und damit die Beurteilung der Wertigkeit der Positronenemissionstomographie (PET) praoperativ und in der Verlaufskontrolle nach Chemotherapie. Patienten, Methoden: Insgesamt wurden 16 Patienten mit HNSCC zweimal praoperativ mit FDG-PET untersucht: Die Basisuntersuchung erfolgte eine Woche vor, die Verlaufskontrolle drei Wochen nach i.a.CHT. Es wurden maximale standardisierte Uptake-Werte (SUVmax) des Primarius und der LKs/ LK-Filiae gemessen und miteinander sowie mit dem histopathologischen Befund verglichen. Ergebnisse: Der SUVmax des Primarius nahm nach i.a.CHT signifikant von einem Median (25. Perzentile/ 75. Perzentile) von 6,4 (4,1/ 7,8) auf 3,6 (2,4/ 6,7) ab (p = 0,01). Von den insgesamt 16 Patienten wiesen 11 Patienten zervikale LK-Filiae auf. Der SUVmax der zervikalen LK-Metastasen nahm von 3,6 (2,3/ 4,8) in der Ausgangsuntersuchung auf 2,3 (1,7/ 3,6) nach i.a.CHT ab (p = 0,008). Nur bei einem Patienten mit LKMetastasierung stieg der SUVmax der LK-Filiae an. Der histopathologisch gemessene Durchmesser der LK-Metastasen lag zwischen 2 und 30 mm. Die histopathologisch nicht als maligne eingestuften LKs wiesen keinen signifikanten SUVmax- Abfall nach i.a.CHT auf (p = 0,13). Schlussfolgerung: Erwartungsgemas wiesen die Primarii der HNSCC einen signifikanten SUV-Abfall nach i.a.CHT auf. Im Vergleich zum Primarius zeigten LK-Metastasen einen geringeren, aber auch signifikanten SUVmax-Abfall. Da zytotoxische Levels nicht systemisch erreicht werden, konnten postentzundliche Reaktionen der LKs oder ein lokoregionarer Lymphabfluss eine Erklarung dafur sein. PET zum Staging des HNSCC sollte daher vor i.a.CHT erfolgen.

頭頸部進行癌に対する超選択的動注療法には，大腿動脈と浅側頭動脈を経由する2通りの方法がある。大腿動脈からのSeldinger法による動注方法は，脳血管障害を引き起こす可能性があるが，浅側頭動脈からの動注では脳血管障害の危険性も少なく，繰り返し動注することも可能である。われわれの用いた経皮的動脈穿刺法は簡便な動注方法であり，耳前部で浅側頭動脈を穿刺し，穿刺部位からガイドワイヤーを挿入してカテーテルを透視下で腫瘍血管に誘導した。投与方法は少量のシスプラチン（20～30mg/m2）を放射線と併用で毎週1回投与し，全身性の副作用はチオ硫酸ナトリウムで中和した。治療成績はCRが80%（12/15例），PRは20%（3/15例）で，全体の奏功率は100%であった。有害事象は，全例で強い粘膜炎を認めたが，全身性の有害事象は軽度の骨髄抑制以外にはみられなかった。動注療法は，機能温存を目的とした治療として有用と思われた。

症例は60歳男性. 1990年より糖尿病と肝機能障害を指摘され, 他院にて経過観察されていた. 2003年10月に心窩部痛のため当院初診, 上部消化管内視鏡検査で十二指腸乳頭部からの出血を認め入院となった. 背景にアルコール性肝硬変があり, AFP, PIVKA-II, AFP-L3分画の上昇に加え肝右葉に多発する腫瘤と門脈腫瘍塞栓を認めることから, 胆道出血を合併した肝細胞癌と診断した. インターフェロン併用肝動注化学療法を開始し, 2クール目からは外来にて化学療法を継続した. 4クール施行途中から胆道感染の悪化を認め, 胆道出血・閉塞性黄疸を最初に発症してから約8カ月後に死亡した. 胆道出血を契機に発見される肝細胞癌は比較的少なく, その予後は不良とされているが, 本症例は画像上腫瘍縮小効果はないものの, 他の報告に比較してインターフェロン併用肝動注化学療法によって延命が得られた1例と考えられた.

頭頸部腫瘍の超選択的動注化学療法について, われわれの経験した172例の結果と成績を検討した。一次治療例の扁平上皮癌症例は主に術前治療として超選択的動注化学療法を用い手術を行った動注・手術群と, 放射線治療と併用を行った動注・根治照射群に分類される。それぞれの5年生存率を検討したところ, 動注・手術群と臓器・機能温存目的の動注・根治照射群の成績はほぼ同等であり, また手術不能進行例の動注・根治照射群でも特にN3症例の治癒率の向上が認められた。種々の合併症が認められたが, 致死的な喉頭・咽頭浮腫, 肺合併症の出現には十分留意する必要があると考えられた。また脳梗塞が5例に合併したが, うち3例は神経症状が残存した。頭頸部腫瘍の治療に際し安全かつ効果的な超選択的動注化学療法の使用法について考察する。

上顎癌・上咽頭癌を除く初発頭頸部扁平上皮癌症例110例にシスプラチン・カルボプラチンを用いた放射線療法併用超選択的動注療法を施行した。経過観察が可能であった79症例 (stage III 18例, stage IV 50例) の治療成績は奏功率 89.9% (CR 82.2%, PR 7.6%, NC 6.4%, PD 3.7%) であった。5年生存率は53例中22例が生存し, 粗生存率41.5% (舌37.5%, 喉頭64.2%, 中咽頭46.2%, 下咽頭22.2%) であった。死因は腫瘍死23例 (遠隔転移死13例), 他病死8例であった。副作用は骨髄抑制によるものが多く, 一過性の意識障害が5例 (4.5%) に, 声帯麻痺・浮腫が5例 (4.5%) に出現した。臓器温存率は81.0%であった。本法は原発巣に対する奏功率が高く, 5年生存率は他の治療法に遜色なかった。副作用・合併症は比較的軽微で, 臓器温存率は著明に高く, 患者のQOLの向上に寄与したと考えられる。

PURPOSE To report a case of regression of advanced retinoblastoma with intraarterial chemotherapy. METHODS A 25-month-old boy presented with extensive endophytic group E retinoblastoma with extensive vitreous seeds and total retinal detachment. RESULTS The patient underwent four sessions of intraarterial chemotherapy after which there was complete regression of vitreous seeds and near-complete calcification of the tumor. CONCLUSION Intraarterial chemotherapy is a novel treatment that is effective in selected cases of retinoblastoma. This technique allows selective delivery of chemotherapy to the involved tumor tissue with minimal systemic absorption.

Purpose To describe the management of kissing macula retinoblastoma tumors treated with intraarterial chemotherapy. Methods Superselective infusion of chemotherapy (combinations of melphalan, topotecan, and carboplatin) into the ophthalmic artery of children with retinoblastoma who had kissing macula tumors was administered on an outpatient basis. Results were assessed with indirect ophthalmoscopy, RetCam digital photography, B-scan ultrasonography, and electroretinograms. Three children with bilateral retinoblastoma (aged 6.1, 7, and 16 months) and kissing macula tumors in an eye were treated. Results All children are alive without the need for removal of the eye, systemic chemotherapy, or external beam irradiation. In each case, the kissing tumors retracted, leaving an anatomically normal fovea. Final 30-Hz flicker electroretinograms were 93.9, 65, and 63.9 μV (under anesthesia). There were no significant systemic toxicities. Conclusion Superselective infusion of chemotherapy by means of the ophthalmic artery of young children with kissing macula tumors resulted in prompt shrinkage of tumors away from the fovea. There were no systemic side effects.

It is well known that many anastomoses can join the external carotid system and the ophthalmic artery. However, their frequency has never been reported. Since they can be relevant for interventional radiologists operating in the orbit, we decided to illustrate and determine the frequency of the anastomoses that can be found in children. A retrospective study of 443 angiographic procedures (via ophthalmic artery and/or external carotid artery) carried out on 97 children affected by intraocular retinoblastoma was made to investigate the arterial anatomy of 106 orbits. Anastomoses were observed in 44.33 % of orbits. However, their true frequency is likely much higher as the rate of visualization increased up to 91.11 % of orbits when the angiographic study was extended to the external carotid artery. In order of frequency we detected the following anastomoses: lacrimal artery—middle meningeal artery, lacrimal artery—anterior deep temporal artery, ophthalmic artery—middle meningeal artery, ophthalmic artery—facial artery, supraorbital artery—superficial temporal artery, supratrochlear artery—superficial temporal artery, supraorbital artery—middle meningeal artery, dorsal nasal artery—infraorbital artery, supraorbital artery—zygomaticoorbital artery, lacrimal artery—zygomaticoorbital artery. When properly searched, anastomoses between the ophthalmic artery and the external carotid artery are almost constant in children. Depending on the clinical scenario, they can represent dangers or valuable alternative routes for collateral circulations and intraarterial chemotherapy.