Shinji Shinohara

Intra-Arterial Injection of Adriamycin/Mitomycin C Lipiodol Suspension in Liver Metastases

Intra-arterial injection of a suspension of adriamycin and/or mitomycin C in Lipiodol was performed in 17 patients with hepatic metastases, which at angiography were poorly vascularized. Accumulation of Lipiodol in the tumors was demonstrated at computed tomography (CT) in 15 of 17 patients examined within one week. Follow-up with CT showed that Lipiodol remained in the tumor during the first month in 94 per cent, after 2 months in 31 per cent, and after 3 months in 17 per cent. In the non-tumor part of the liver Lipiodol disappeared earlier, and one month after injection it could no longer be traced on CT. In 8/17 cases (47%) CT, after intra-arterial injection of Lipiodol, gave superior information compared with CT after intravenous contrast enhancement. Tumor response was achieved in 9 of 16 cases. Particularly in metastases originating from cancer of the colon and stomach response was observed with a decrease in tumor size in 8 of 10 patients.

Intra-arterial cis-platinum infusion with sodium thiosulfate protection and angiotensin ii induced hypertension for treatment of hepatocellular carcinoma

Cis-diamminedichloroplatinum II (CDDP; 52–169 mg/m2) mixed with angiotensin II (1.5–10 μg/min) was infused into the hepatic artery in 33 patients with hepatocellular carcinoma. Simultaneously, sodium thiosulfate (10–50 g) was administered intravenously in order to reduce the systemic toxicity of CDDP. Over 50 per cent reduction in tumor size was obtained in 18 patients (55%). Complete response was achieved in 4 patients (12%). Serum alpha-fetoprotein (AFP) levels decreased by more than 75 per cent in 10 of 18 patients in whom the previous AFP level was more than 200 ng/ml. The one year survival rate was estimated at 61 per cent by the Kaplan-Meier method. Alimentary symptoms (nausea, vomiting) were mild or non-existent in nearly 90 per cent of treatments. Peptic ulcer and abdominal pain were manifested in small numbers. Severe changes in the laboratory data were not observed. High dosage arterial infusion of CDDP and angiotensin II and intravenous injection of sodium thiosulfate was well tolerated and gave effective therapy in hepatocellular carcinoma.

Treatment of Liver Metastases by Arterial Injection of Adriamycin/Mitomycin C Lipiodol Suspension

Sixty-one patients with liver metastases were treated with hepatic arterial injection of Adriamycin/Mitomycin C oil suspension (ADMOS). The liver metastases originated from the gastrointestinal tract in 41 patients and from other organs in 20 patients. Sixty-nine liver tumors were analyzed in these 61 patients. Computed tomography (CT) after ADMOS injection (Lip-CT) gave more information in 19 cases (31%) than enhanced CT with a water-soluble contrast medium. With Lip-CT, Lipiodol tumor enhancement was observed in 64 of 69 lesions. The patterns of Lipiodol uptake in the tumors were classified into 4 types: Homogeneous accumulation (20%), heterogeneous accumulation (16%); accumulation with a central defect (57%); and no accumulation (7%). A tumor response was achieved in 41 of 69 lesions (59%). Anticancer effects were also shown as a decrease in serum CEA levels. The one year survival rate estimated by the Kaplan-Meier method was 43 per cent and the median survival time was 337 days. The results were better among patients who received multiple doses of ADMOS. Only minimal side effects were associated with ADMOS. The method is considered to be an excellent diagnostic and therapeutic procedure for liver metastases.

TREATMENT OF LUNG CANCER WITH BRONCHIAL ARTERY INFUSION OF CISPLATIN AND INTRAVENOUS SODIUM THIOSULFATE RESCUE

Forty-nine patients with primary lung cancer were treated with bronchial artery infusion of cisplatin and intravenous injection of and antidote, sodium thiosulfate. More than 50% reduction of tumor size (PR) was observed in 8 of 9 small cell carcinomas (SCLC) and in 16 of 40 non-small cell carcinomas (NSCLC). In NSCLC patients PR was obtained in 71% (12/17) after repeated infusion (greater than or equal to 200 mg cisplatin) and in 17% (4/23) after a single infusion (less than or equal to 150 mg cisplatin). There was a significant linear relationship between cisplatin dose and tumor reduction in this group. No severe adverse effects were encountered.

Differentiation of bronchogenic carcinoma from secondary changes, obstructive pneumonitis and/or collapse by I-123 IMP lung imaging.

Serial lung images with N-isopropyl-p-[I-123]-iodoamphetamine (I-123 IMP) were obtained to assess the imaging findings and to clarify the lesion to uptake relationships in 74 lesions in 73 patients with various histological types of bronchogenic carcinoma. A decreased uptake area was observed in all 74 lesions in the initial one or two-min I-123 IMP image. The initial image was analogous to a Tc-99m MAA lung perfusion image in 70 patients in whom both lung imaging procedures were performed. The imaging findings changed following this initial phase. At 4 hr, the lesion was depicted as either areas of decreased uptake or increased uptake or a combination of the two. Comparison between the lesion findings in the 4-hr I-123 IMP images, radiograms and removed specimens revealed that areas of decreased uptake corresponded to the cancerous portions of the lung mass or pleural effusion and areas of increased uptake corresponded to inflammatory portions including obstructive pneumonitis and/or collapse. Thus, the 4-hr I-123 IMP lung images can be used to discriminate the cancerous portion from associated secondary changes, obstructive pneumonitis and/or collapse.

The influence of age on N-isopropyl-p-[123I]iodoamphetamine accumulation in the human heart

Variations in heart intensity in the 30 min and 4 hr chest images of the radiolabelled lipophilic amine, N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) were observed in 130 patients with lung diseases, aged 23 to 85 yrs. The heart intensity had a significant positive linear correlation with age (r=0.43 at 30 min, 0.66 at 4 hr). The ratio of 4 hr heart intensity to 30 min heart intensity also had a positive linear correlation (r=0.59), suggesting slower clearance of the radioactivity from the heart in older than in younger patients during this interval. Other parameters including sex, EKG findings, liver function, blood pressure, the presence of diabetes mellitus and smoking history had no relationship to heart intensity. A significant difference between heart intensities in bronchogenic carcinoma and pneumonia patient groups might be probably due to the age difference between the two groups. Therefore heart intensity in the 4 hr123I-IMP image may reflect certain metabolic and/or myocardial change(s) with aging.

Intra-arterial digital subtraction angiography

Computed radiography (CR) produces an image with frequency enhancement and a digital subtraction angiogram (DSA) as well as an image similar to that obtained with the conventional screen/film system. CR is thus recognized as a new system which can deal with many angiograms. This chapter presents clinical cases of intra-arterial DSA using CR and the advantages and problems of this system are discussed.