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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.

動脈内にリザーバーカテを留置し，化学療法を行う治療の長期的な予後と合併症についての報告は少ない．（対象と方法）動注化学療法を行った消化器癌症例45例．内訳はHCC10例，大腸癌からの転移性肝癌15例，胃癌，大腸癌による腹膜播種20例である．肝癌症例には肝動脈に，腹膜播種症例には大動脈内にリザーバーカテを留置し，low dose CDDP，5FU，アイソボリンを用いた化学療法を主に外来で行った．肝動脈に留置したカテは頚部から4例，そけい部から17例，開腹時４例挿入した．予後および合併症について比較検討した．（成績）肝癌症例および腹膜播種症例の1年生存率はそれぞれ64％，32％で２年生存率は36％，15％であった．合併症は11例にみられ，うち6例（TIA，皮膚色素沈着，腸管の潰瘍，肝障害）がカテ挿入後1カ月以内に，5例（肝動脈閉塞，肝動脈瘤，敗血症，カテの閉塞，創感染）が6カ月以降の晩期にみられた．カテの挿入経路別では頚部からの1例にTIA がみられた他は特徴的なものはみられなかった．（結語）肝動脈内にリザーバーカテを長期留置し化学療法を行うと，動脈の閉塞や動脈瘤がみられやすいと思われる．また頚部よりカテを挿入するとTIA の引き金となりやすい．その対策として現在当科では，カテをあまり奥にまで留置しないことやそけい部からのアプローチを選択している．

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。