Takashi Iwamiya

Repeated arterial infusion chemotherapy for inoperable hepatocellular carcinoma using an implantable drug delivery system

Arterial infusion chemotherapy has become one of the major treatments for malignant tumors. Since 1988, we have attempted repeated arterial infusion of anticancer drugs using an implantable drug delivery system in 68 patients who had inoperable hepatocellular carcinoma (HCC). Most of our patients could not undergo transcatheter arterial embolization (TAE) because of extreme tumor extension and/or accompanying advanced liver cirrhosis. In most patients we implanted a 5-F catheter via the femoral artery nonsurgically and connected it to a subcutaneously implanted drug delivery system without any difficulty. The treatment consisted of weekly or biweekly intrahepatic one-shot administration of anticancer drugs. As one therapeutic regimen, epirubicin was given alone. Other regimens consisted of combined chemotherapy using two or more of the following drugs: mitomycin C, Adriamycin, 5-fluorouracil, cisplatin, and epirubicin. In some cases, these drugs mixed with Lipiodol were given for targeting and slow release in the liver. The response rate (CR+PR) of the cases was 25.0%. The median survival period was 389.9 days. The 6-month, 1-year, and 2-year survival rates were 75%, 45%, and 17%, respectively. There was no severe side effect or complication except arterial occlusion that precluded further infusion chemotherapy. We think that the implantable drug delivery system will contribute not only to improved therapeutic efficacy for inoperable HCC but also to an improved quality of life for the patients.

Application of expandable metallic stents to the venous system

Expandable metallic stents were successfully introduced in 12 patients; 6 with superior vena cava (SVC) obstruction due to tumor invasion or lymph node metastases, 3 with inferior vena cava (IVC) obstruction or stenosis due to lymph node metastases or hepatic tumor, one with common iliac vein (CIV) obstruction due to lymph node metastases, one with idiopathic obstruction of the hepatic IVC and Budd-Chiari syndrome, and one with CIV obstruction following a dialysis shunt. The length of the lesions was between 2 and 15 cm. Multiple (2–7) stents in tandem were inserted percutaneously from a femoral venous approach through a 12 to 16 F (4.0–5.3 mm) Teflon sheath. Postoperatively, all 12 patients became free from symptoms such as SVC syndrome or IVC syndrome. In 11 patients, the symptoms did not recur during the follow-up periods of 1 to 21 months.

Treatment of Tuberculous Bronchial Stenosis with Expandable Metallic Stents

Gianturco expandable metallic stents were placed in 5 patients with dyspnea on exercise due to tuberculous bronchial stenosis. The stents were placed after dilatation with a 10-mm diameter high pressure balloon catheter. In all 5 patients, obstructive changes disappeared following the procedure, and dyspnea on exercise improved markedly. No complications related to the procedure were encountered. At follow-up during a period of up to 38 months, 2 patients showed bronchial restenosis at 11 and 17 months, respectively, after stent placement. Restenosis by granulomatous tissue was successfully treated by laser ablation. One patient showed slight one-day hemoptysis 26 months after stent placement.

Initial experiences of chondroitin sulfate iron colloid-enhanced MR imaging in patients with hepatocellular carcinoma: comparative study with CT during arterial portography

Abstract Chondroitin sulfate iron colloid (CSIC), a stable iron colloid preparation, is used for the treatment of iron deficiency anemia in Japan. CSIC administered intravenously accumulates in reticuloendothelial cells and reduces the signal intensity of the liver at magnetic resonance imaging (MRI) because of its T2*-shortening effect. Accordingly, CSIC produces a contrast between normal liver tissue and hepatocellular carcinoma (HCC) which has diminished reticuloendothelial function, enabling improved detection of HCC by MRI. In this study, we compared CSIC-enhanced MRI with computed tomography during arterial portography (CT AP), which is considered the most reliable imaging modality to detect HCC. Of 20 HCCs pathologically confirmed in 16 patients, 18 (90%) were detectable with CT-AP. Sixteen HCCs (80%) were detectable with unenhanced MRI. After the administration of CSIC, 18 (90%) could be detected. CSIC-enhanced MRI was found to be superior to CT-AP in the detection of HCCs in patients with portal flow abnormalities, i.e., porto-systemic shunting, laminal flow of contrast material and wedge-shaped perfusion defect. In contrast, CT-AP was found to be superior to CSIC-enhanced MRI in detecting HCCs of less than 1 cm in diameter. We consider that these imaging procedures are complementary to each other, and their combined use is the most reliable method by which to detect HCC.

The potential use of I-123 IMP scintigraphy for pelvic bone metastases in hepatocellular carcinoma. A comparison with Ga-67 scintigraphy

Conventional bone scintigraphy is often inconclusive in detecting bone metastases of hepatocellular carcinoma, suggesting the necessity of alternative scintigraphic agents. In this study, the diagnostic value of I-123 IMP scintigraphy was evaluated in 8 patients with 12 pelvic bone metastases from hepatocellular carcinoma, then compared with Ga-67 scintigraphy. Eleven of 12 lesions (91.7%) were detected by I-123 IMP scintigraphy; Ga-67 scintigraphy visualized 8 lesions (66.7%) in the same patient population. I-123 IMP scintigraphy is useful for detecting pelvic bone metastases of hepatocellular carcinoma with less physiologic accumulation in the intestine as compared with Ga-67 scintigraphy.

Intraarterial Occlusion by Radiofrequency

Arterial occlusion using radiofrequency energy was performed. The length of the noninsulated part of the guidewire was 10 mm and the duration of radiofrequency supply was 20 s. Animal experiments were carried out in 17 canine arteries; 4 out of 6 arteries less than 2.3 mm in diameter were completely occluded during the 20 s radiofrequency supply. A clinical application was also successfully performed without any complications. Arterial occlusion with radiofrequency can be applied to vessels less than about 2 mm in diameter.

Increased uptake of I-123 IMP in peritoneal metastases of hepatocellular carcinoma

1-123 IMP is now widely used as a radioactive agent for cerebral blood flow scintigraphy. It is also known to accumulate in certain types of tumors. The authors present a case in which 1-123 IMP accumulated in peritoneal metastases of hepatocellular carcinoma.

Clinical Experience of 123I-IMP Scintigraphy in Detecting Vertebral Bone Metastases of Hepatocellular Carcinoma A Comparison with Bone Scintigraphy with 99mTc-MDP

Although bone scintigraphy with 99mTc-MDP is a sensitive diagnostic method to detect bone metastasis, it is not specific for malignancy. A radioactive substance which accumulates specifically into metastatic lesions should be of value. 123I-IMP and bone scintigraphy with 99mTc-MDP were consecutively performed in patients with vertebral bone metastases from hepatocellular carcinoma and lumbar spondylosis deformans in a 7-day interval or shorter. The intensity of uptake was compared. Eighteen of the 20 metastatic lesions (90%) were classified as increased uptake areas in 123I-IMP scintigraphy. MDP-scintigraphy disclosed 16 metastatic lesions (80%), 9 as “hot” lesions (56%) and 7 as “cold” lesions (44%). 123I-IMP scintigraphy was negative in all 12 lesions of lumbar spondylosis deformans. Compared to MDP-scintigraphy, 123I-IMP scintigraphy was more sensitive in detecting vertebral bone metastases of hepatocellular carcinoma with smaller rates of false-positive and false-negative findings.