Hepatic arterial port systems for treatment of liver metastases: factors affecting patency and adverse events.

PURPOSE: To assess the outcome of interventional hepatic arterial port placement in a prospective phase II trial. MATERIALS AND METHODS: One-hundred five consecutive patients were included in this study. Primary endpoint was port patency; secondary endpoints were complications, toxicity, response, and progression free and overall survival. Seventy-eight patients presented with liver metastasis only, 6 patients had additional minor extrahepatic disease, and 21 patients had no evidence of disease after liver resection, laser-induced thermotherapy, or computed tomography (CT)-guided interstitial brachytherapy of liver metastasis. Exclusive access route was the femoral artery. Subgroup analysis compared either 4-F catheters (n = 58) to 2.2-F (n = 33) and 2.7-F (n = 20) microcatheters or different strategies in anatomic variants of the celiac branch: neglect (n = 10) or embolization of minor hepatic feeders (n = 11), splenic arterial port (n = 8), double port (n = 7). RESULTS: Technical success was 99%. Assisted port patency after 6 months was 93%. Complications demanding port revisions were significantly lower in patients receiving 4-F versus 2.2-F and 2.7-F systems (P <.001), with disconnection as the major problem with use of microcatheters. Hepatic artery thrombosis occurred in 10 patients (9%), with successful lysis in two patients. With use of 4-F and 2.2-F catheters, there was no difference with respect to catheter occlusion or hepatic thrombosis. No differences were noted in complications or outcome applying four different strategies in celiac branch variants. In a subgroup of patients receiving folinic acid/5-fluorouracil (170 mg/600 mg; 10% dose escalation per cycle) for 5 days every 4 weeks only 15% experienced Grade 3 toxicity. Patients with liver metastasis and salvage therapy demonstrated progression-free survival of 63% after 6 months and a median survival of 16 months. CONCLUSION: Interventional placement of hepatic arterial port systems may overcome frequent hepatic arterial chemotherapy failures as encountered in all published major trials on hepatic arterial infusion.

Intratumoral infusion of interleukin-1beta and interferon-gamma induces tumor invasion with macrophages and lymphocytes in a rat glioma model.

Malignant gliomas are hard to treat successfully. Like other treatments immune therapy fails presumably due to low concentration of immune modifiers within the tumor. However, convection-enhanced delivery (CED) may overcome this problem. So, we analyzed the effect of intratumoral delivery of interleukin (IL)-1beta and interferon (IFN)-gamma by CED on tumor immune cell invasion in a rat glioma model. Tumors were implanted into the left caudate nucleus and tumor growth was demonstrated by MRI. Afterwards intratumoral infusion of IL-1beta or IFN-gamma was started for 48 h. Then animals were sacrificed and the number of tumor infiltrating CD4+ and CD8+ lymphocytes as well as macrophages was analyzed by immunohistochemistry. Our results demonstrate that intratumoral cytokine infusion using CED leads to a strong tumor invasion with macrophages and lymphocytes suggesting a tumor specific immune response.