ARTERIAL CHEMOINFUSION IN PATIENTS WITH LOCALLY ADVANCED AND METASTATIC PANCREAS CANCER.

The chemoinfusions (310) were carried out in celiac trunk in 167 patients with non-removed pancreas cancer at the period from 2000 to 2015. Locally advanced timorous process (stage III, n=79) was revealed in 79 patients and liver metastases (stage IV, n=88) were noted in 88 cases. The celiac axis infusion by Gemcitabine (1000 mg/m²) was applied for patients and GEMOX (Gemcitabine+Oxaliplatin 75 mg/m²) has been using since 2012. Symptomatic improvement such as decrease of pain, growth of body weight was noted in majority of patients. An average lifetime, median and one-year survival consisted of 7,6 months, 5,8 months and 10%. The patients (133) were treated by 1­2 cycles and after that by course of total body chemotherapeutics. There weren't any serious complications. Toxic manifestations of chemotherapy weren't higher than I­II degree and they were arrested by corrective therapy in 92 patients (55%). The celiac axis infusion is safe in patients with locally advanced and inoperable pancreas cancer. Symptomatic improvement showed the most patients. The objective response to the treatment had 20% patients and performance of repeated cycles led to increase of their survival.

[Regional chemotherapy in treatment of patients with unresectable liver metastases of uveal melanoma].

PURPOSE: Retrospective efficacy analysis of transcatheter arterial treatment for unresectable liver metastases of uveal melanoma. MATERIALS AND METHODS: There were performed 38 courses: hepatic arterial chemoembolization with Lipiodol (HACE, n 9) and combination of HACE with hepatic artery infusion (HAI, n = 29). In 9 patients we used the following chemotherapeutic agents: doxorubicin (10-50mg), carboplatin (150 to 450 mg), dacarbazine (200-400mg), mustophoran (360-624mg) and mitomycinum C (5-10mg). RESULTS: There were no mortality or serious complication. According to mRECIST, partial response, stabilization and progression of liver metastases was seen in 1, 3 and 5 patients, retrospectively. The mean survival after arterial treatment was 9,4 (2-34) mo. The 6-, 12- and 18- mo survival rates were 56%, 22% and 11% respectively. CONCLUSION: Transcatheter therapy in unresectable liver metastases of uveal melanoma is safe and can prolong survival of selected patients up to 34 mo.

[ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group.

[Long-term results of combined x-ray endovascular surgical treatment of patients with ductal adenocarcinoma of the pancreatic head].

On the basis of the results of treatment of 105 patients with locally advanced ductal adenocarcinoma of the pancreatic head the authors present the results of work over a period of time since 1999 to 2009. In the main group the combined treatment was used for 51 patients: the non-adjuvant selective chemoembolization of the pancreatic head adenocarcinoma was performed, than standard gastropancreatoduodenal resection with lymphodesection and 6 cycles of adjuvant chemoinfusion in celiac trunk were completed. In control group standard gastropancreatoduodenal resection was performed. In the group of combined treatment the 1-, 2-, 3-year survival rates consist of 80.4%, 58.8% and 43.1%, respectively. The average life span was 22.3+/-2.1 months. The average life span of 54 patient of control group was 8.4+/-2.1 months and a common 3-year survival consists of 13%. There was no lethality after the performance of X-ray endovascular procedures and gastropancreatoduodenal resection. Postoperative complications reliably didn't differ in both groups.

[Roentgenoendovascular hemostasis of arterial bleeding after major surgery for pancreatic cancer].

The efficacy of angiographic hemostasis in cases of massive arterial bleeding after major pancreatic resection was evaluated. Late life-threatening arterial hemorrhage developed in 3 out of 65 patients (4.6%) within 12, 20 and 42 days after pancreatic carcinoma resection. In all cases emergency roentgenoendovascular procedures were fulfilled for hemostasis. Six therapeutic angiographic procedures (from one to three per a patient) were performed. All of them were clinically and technically successful. Depending on the bleeding localization and the character of vascular lesion, the embolization (n = 5) or stent-grafting (n = 1) were used. The further prognosis was dependent on the success of treatment of complications and the course of the malignant disease. The emergency angiography with endovascular hemostasis appears to be the method of choice in treatment of postoperative visceral bleedings especially in patients with high surgical risk.

[Complications of trans- and suprapapillary percutaneous and transhepatic stenting of bile ducts in patients with mechanical jaundice of tumorous etiology].

The authors made an analysis of complications in percutaneous endobiliary prostheses in 82 patients for obturative jaundice of tumorous etiology. The stents were placed over the major duodenal papilla and transpapillary. There were no lethal outcomes. Complications developed in 10 patients (12.2%) were: purulent cholangitis, stent migration or occlusion, abscess of the anterior abdominal wall, formation of biloma and hemobilia. Complications were arrested using conservative methods of treatment and/or minimally invasive procedures. Endoprostheses of bile ducts were shown to be an effective and relatively safe method of correction of mechanical jaundice of tumorous etiology. The number of complications in transpapillary stenting was not greater than in suprapapillary method.

[Role of arterial embolization in bilateral kidney cancer].

From 1995 to 2006 we performed embolisation in 9 patients with bilateral kidney cancer. Embolization of kidney with smallest cancer was done at the first stage with subsequent embolisation of tumor in the contralateral kidney. Technically all procedures were successful and were performed without complications. Operative intervention on the contralateral kidney was undertaken 1-4 months after embolization in 8 patients. Five patients are alive for 5 and more years. Four patients died in 34-49 months after intervention. Selective embolization is a safe and effective modality which expands our abilities to treat patients with bilateral kidney cancer. Embolization can be used as single treatment modality and in combination with subsequent surgery.

[Direct results of endovascular prosthetics of aneurysms of the infrarenal part of the aorta in patients with a severe concomitant pathology].

From May 2007 to March 2009 under observation there were 58 patients aged from 52 to 79 years (mean age 68) with the diagnosis of abdominal aortic aneurysm (AAA). Selection of patients for endoprosthesis was performed by the data of spiral computed aortography. The endovascular exclusion ofAAA from blood flow was performed in 15 patients. All the patients had high risk of surgery because of multiple concomitant pathologies. In 14 (93%) patients bifurcational and in 1 patient aortofemoral unilateral prostheses of AAA were made with the application of femoro-femoral bypass. All implantations were technically successful without complications. Shorter time of operation, less intraoperative blood loss, shorter tine of staying in hospital and time of rehabilitation were found to be 1.5-3 times as compared with classical surgical intervention. Implantation of bifurcational stent-graph seems to be the method of choice in treatment of AAA patients with severe concomitant pathology.

[Role of intrventional radiology in pre- and postoperative periods of liver transplantation].

The purpose of this study was to prove the use of interventional radiological procedures before and after liver transplantation (LT). Between 1998 and 2009 years, 54 LT were performed in 52 patients. 18 patients received 19 interventional radiological treatments including 11 preoperative (trans-catheter oily chemoembolization of hepatocellular carcinoma, n=3; transjugular intrahepatic portosystemic shunting, n=8) and 8 postoperative (drainage or stenting of biliary strictures, n=4; balloon dilatation and/or stenting of inferior vena cava or cava-caval anastomosis, n=3; splenic artery embolization in sleal syndrome, n=1). It is concluded that before LT, trans-catheter embolization delays the growth of hepatoma and prolongs time for donor liver waiting. Transjugular portosystemic shunt decreases the risk of fatal variceal bleeding. Post-LT complications such as vascular or biliary strictures and steal syndrome can be also effectively corrected by methods of interventional radiology.

[Arterial embolization as palliation for inoperable renal carcinoma].

Embolization of the renal artery was performed as a palliative measure in 93 inoperable patients at the Center's Clinic in 1991-2000. Radio-endovascular intervention was indicated in cases of bleeding (19, 20.5%), case-history macrohematuria with high risk of relapse (54, 58%) and drug-controlled pain (20, 21.5%). Bleeding was suspended for 3-16 days (average 7.5 +/- 4) after occlusion of the artery in 16 out of 19 patients and decreased significantly in 3 (16%). There was no bleeding after embolization among macrohematuria patients. Pain syndrome was abated in 70% while post-intervention complications occurred in 13%: they were transitory in 6.5% and--fatal in another 6.5%. Catheter-assisted arterial embolization is a fairly safe and efficient means of arresting bleeding from inoperable renal kidney coupled with marked analgesic effect.

[Methods of correcting hepatic arterial blood supply for subsequent implantation of the "port-catheter" infusion system].

The study was undertaken to investigate the feasibility of using surgical and roentgenoendovascular redistribution of the hepatic arterial blood flow for adequate implantation of the "port-catheter" infusion system. Between December 2001 and March 2008, we performed surgical (n = 25) or transcutaneous (n = 22) implantations of the infusion systems for carrying out regional chemotherapy in a total of forty-seven patients presenting with hepatic metastases of colorectal carcinoma. Anatomical variants of the hepatic arteries were observed in eleven cases. The blood stream was corrected by means of either transcatheter embolization (n = 7), ligation (n = 2), or transposition (n = 2) of the aberrant arteries. No complications were encountered. In all the cases, the "port-catheter" system was implanted successfully, with adequate hepatic perfusion achieved. Both transcatheter embolization and surgical reconstruction turned out to be efficient methods in correction of the blood flow in various anatomical structures of the hepatic arteries, thus favourably contributing to increased efficacy of regional chemotherapy.

[Intra-arterial chemotherapy and chemoembolization in the combined treatment for locally advanced carcinoma of the head and neck].

We evaluated the role of intra-arterial chemotherapy and/or chemoembolization, intravenous systemic chemotherapy and radiotherapy in combined treatment for locally advanced unresectable carcinoma of the head and neck. Transfemoral approach for catheterization with chemoinfusion/chemoembolization of the external carotid artery branches with carboplatin (300 mg/m2), 5-fluorouracil (1000 mg/m2) and gelatin sponge was attempted in 25 patients. Out of that number, 18 received additional radiotherapy. Bleeding episodes and relevant high risk in the future were indications for embolization treatment. There was complete (2) and partial (8) tumor regression or stabilization (5) (83%), progression (3) (17%). Arterial and systemic chemotherapy without irradiation resulted in one partial response, 3 cases of stabilization (57%), and 3 cases of progression (out of 7) (43%). There were no episodes of chronic tumor-related bleeding (7). Hence, combined treatment for locally advanced carcinoma of the head and neck including intra-arterial chemotherapy, chemoembolization, intravenous systemic chemotherapy and radiotherapy can be safely delivered with high response rates and low systemic toxicity. Since all these measures are accompanied by relatively low risks of chronic bleeding a choice of palliative or radical dosage of radiation is possible.

[Rentgenoendovascular interventions into treatment of patients with unresectable metastases of gastric cancer into the liver].

In the period from 1992 through 2006 transcatheter therapy was carried out in 46 patients with unresectable metastases of gastric cancer (MGC) into the liver. Repeated cycles of chemoinfusions in the hepatic artery (CIHA) with 5-fluorouracil, doxorubicine, mitomicine C and carboplatin were made to 35 patients. Chemioembolization of hepatic arteries (CEHA) using the same cytostatics and oil contrast agent was made toll patients. After CIHA a partial response to treatment and stabilization of the tumor growth was noted in 14 (40%) patients, progressing metastases in 21 (60%) patients. Mean survival period of 32 dead was 14.6 +/- 1.5 month and the indices of 1-, 2- and 3 years survival were 46, 15 and 5 % respectably. After CEHA a partial response and stabilization of the tumor growth were noted in 7 (63%) patients and in the rest 4 patients (37%) there was progressing. The mean survival period of 9 dead patients was 15.5 +/- 3.3 months; the indices of 1-, 2- and 3 years survival were 55, 18 and 10 % respectively (p(CINA-CEHA) > 0.01). The methods of interventional radiology are thought to be perspective for treatment of unresectable metastases into the liver.

[Transcatheter treatment of liver metastases from breast cancer].

Transcatheter treatment for liver metastases from breast cancer was given to 55 patients (1995-2006): hepatic artery infusion (HAI) with 5-fluorouracil, doxorubicin and carboplatin--11; hepatic artery oil chemoembolization (HAOC) with doxorubicin--14; taxotere (Docetaxel)--17; HAI+HAOC--13. Partial response was reported in 18%, stabilization--27%, metastatic progression--55%. Mean survival (MS) of all deceased patients--11.9 +/- 1.5; 1-, 2- and 3-year survival--40, 20 and 0%, respectively. HAOC: partial response and stabilization--42%, progression--58%. As of January 2007, 7 patients survived 8-22 months (mean 14.3 months); 24 deceased had survived 16.8 +/- 3.3 months. HAOC+HAI: complete response--8%, partial--23%; stabilization--44%; progression--25%. Three patients have survived 24, 33 and 82 months; mean survival of 10 deceased--19.9 +/- 4.5 months, their 1-, 2- and 3-year survival was 90, 60 and 20%, respectively.. Mean survival of doxorubicin-treated patients was 18.9 +/- 1.6, taxotere--24.8 +/- 5.1 months (p < 0.05); 1-, 2- and 3-year survival- 57, 29 and 7%, and 88, 35 and 24%, respectively. HAOC+HAI was the most effective while application of taxotere was followed by longest mean survival.

[Intraarterial chemotherapy using implantable port-catheter system in patients with colorectal liver metastases].

We evaluated the tentative clinical results of port-catheter system implantation in 32 patients (18 males and 14 females) with liver metastases of colorectal cancer (2001-2006). Laparotomic approach was used in 17 and percutaneous transfemoral implantation - in 15 patients. There were no complications nor technical problems. All patients received a total of 160 cycles of infusion chemotherapy, ranging 2-11 (4 on the average); mean follow-up - 241 (57-730) days . At present, 21 patients have survived for 5-28 months. Three of them (14%) report complete response, 13 (62%) - stabilization and 5 (24%) - tumor progression. One-year survival in all patients was in 76.5%. Eleven patients died through tumor progression unrelated to the liver.

Preoperative portal vein embolization for liver malignancies.

BACKGROUND/AIMS: To study effectiveness of preoperative portal vein embolization before extensive hepatic resection in patients with primary or secondary liver malignancies. METHODOLOGY: Between December 1997 and May 2003, right portal vein embolization was performed in 24 patients. The indication to the procedure was a small amount (< 30%) of the future remnant liver. Ultrasound-guided percutaneous transhepatic puncture of the portal vein and embolization of its right lobar branch with Lipiodol, ethanol, gelatin sponge and/or steel coils were used. RESULTS: There were no complications of the procedure. In 19-56 (mean, 30) days, CT or MRI showed significant increase of the future remnant liver volume from 25% to 35% of the whole liver; the mean increase was 40%. Laparotomy was performed in 15 patients. Right, extended right hepatectomy, and repeated resection were performed in 7, 6, and 1 patient respectively, while one patient underwent only exploration because of tumor progression. Of 14 resected patients, 11 showed no postoperative liver failure. The latter was medically cured in two of three remaining patients, while one patient (future remnant liver < 30% even after the embolization) died from liver failure in 20 days after the surgery. Hepatic resection is planning in 4 of 9 non-operated patients. The 5 patients were not operated because of tumor progression. CONCLUSIONS: Right portal vein embolization is a safe and technically simple procedure that decreases the risk of postoperative hepatic failure after major liver resection.