Safety and efficacy of the PleurX catheter for the treatment of malignant ascites.

BACKGROUND: Malignant ascites is a common complication seen in association with various types of neoplastic processes. Due to high recurrence rates, patients may require multiple paracenteses, which have associated complications such as increased risk of bleeding, infection, pain, and volume and electrolyte depletion. OBJECTIVE: This study evaluated the management of malignant ascites by placement of the PleurX® tunneled catheter system at a single center. METHODS: This was a retrospective study of 38 patients who underwent PleurX catheter placement for refractory malignant ascites between February 2006 and March 2012 at our institution. Pretreatment characteristics and outcome measures were reported using descriptive statistics. RESULTS: The population included 21 males and 17 females with a mean age of 60.6 years (range, 36-79 years) diagnosed with metastatic disease from a variety of primary malignancies, the most common of which was pancreatic cancer (10 patients). In 84% of patients (32/38) who were not lost to follow-up, mean survival time was 40.7 days (range 4-434 days). Technical success rate of catheter placement was 100%. CONCLUSIONS: The PleurX catheter can be used to manage malignant ascites in severely ill patients with metastatic cancer, with a high rate of procedural success and a low incidence of potentially serious adverse events, infections, or catheter-related complications.

Transarterial chemoembolization using DEBIRI for treatment of hepatic metastases from colorectal cancer.

BACKGROUND/AIM: Dismal survival rates of metastatic colorectal cancer (mCRC) to the liver have been recorded. Transarterial chemoembolization (TACE) with irinotecan eluting beads (DEBIRI) may be a safe palliative treatment with fewer serious adverse effects (SAEs). We aimed to establish the safety and efficacy of DEBIRI TACE in the treatment of hepatic metastases from colorectal cancer (CRC). PATIENTS AND METHODS: A retrospective analysis of DEBIRI TACE was performed. Response was assessed using the m-RECIST criteria. The Common Terminology Criteria for Adverse Events (CTCAE v3.0) were used to record toxicity. Survival was estimated using Kaplan Meier analysis. RESULTS: Twenty-eight patients treated with 47 DEBIRI TACE procedures were followed from September 2008 until February 2012. Twenty-two had metastases from colonic cancer and six metastases from rectal cancer; three patients (15%) had complete response, six (30%) partial response, four (20%) stable disease and disease progression was recorded in seven (35%); computer tomography (CT) scans were unavailable for eight patients. AEs included gastrointestinal and acid-base disturbances, hypertension, fever, insomnia, chest pain, pruritus, and neutropenia; five patients did not present AEs. The median time from diagnosis of liver metastases to initial DEBIRI treatment was 19.6 months. The median follow-up was 6.9 months. The median overall survival from first treatment was 13.3 months (95% confidence interval=6.8-19.8 months). CONCLUSION: DEBIRI is a well-tolerated treatment option that can be used safely in the palliative treatment of hepatic metastases from CRC.