Complications Encountered with a Transfemorally Placed Port-Catheter system for Regional Chemotherapy of Hepatobiliary-Pancreatic Tumors

Purpose: To determine the rate of complications associated with a port-cathetersystem implanted via the femoral arterial access for hepatic arterial chemotherapeuticinfusion.Materials and Methods: One-hundred thirteen patients with liver metastases andprimary hepato-biliarypancreatic tumors underwent the procedure. The infusion catheterwas connected to a port implanted subcutaneously below the level of the inguinalligament.Results: Implantation of the system was successful in 107 of 113 patients (94.7%). Wedid not treat with infusion chemotherapy on 5 of 107 patients because of poor generalcondition. The observation period after placement ranged from 4 to 787 days (mean 233days). Complications after system placement were observed in 18 of 102 patients (17.6%),These included hepatic arterial injury (7.8%) with a mean system use of 361 days (range24-671 days), pocket trouble (4.9%) with a mean ,system use of 253 days (range 21-624days), port-catheter system obstruction (3.9%) with a mean system use of 100 days(range 62-263 days) and significant catheter dislodgement from the target artery (2.9%)with a mean system use of 384 days (range 358-436 days).Conclusion: Our data suggested that it was feasible and safe to place the port-cathetersystem percutaneously via the femoral artery

Complications Encountered with a Transfemorally Placed Port-Catheter system for Regional Chemotherapy of Hepatobiliary-Pancreatic Tumors

Purpose: To determine the rate of complications associated with a port-cathetersystem implanted via the femoral arterial access for hepatic arterial chemotherapeuticinfusion.Materials and Methods: One-hundred thirteen patients with liver metastases andprimary hepato-biliarypancreatic tumors underwent the procedure. The infusion catheterwas connected to a port implanted subcutaneously below the level of the inguinalligament.Results: Implantation of the system was successful in 107 of 113 patients (94.7%). Wedid not treat with infusion chemotherapy on 5 of 107 patients because of poor generalcondition. The observation period after placement ranged from 4 to 787 days (mean 233days). Complications after system placement were observed in 18 of 102 patients (17.6%),These included hepatic arterial injury (7.8%) with a mean system use of 361 days (range24-671 days), pocket trouble (4.9%) with a mean ,system use of 253 days (range 21-624days), port-catheter system obstruction (3.9%) with a mean system use of 100 days(range 62-263 days) and significant catheter dislodgement from the target artery (2.9%)with a mean system use of 384 days (range 358-436 days).Conclusion: Our data suggested that it was feasible and safe to place the port-cathetersystem percutaneously via the femoral artery

Predictive factors of uterine movement during definitive radiotherapy for cervical cancer

To determine the predictive factors affecting uterine movement during radiotherapy (RT), we quantified interfraction uterine movement using computed tomography (CT) and cone-beam CT (CBCT). A total of 38 patients who underwent definitive RT for cervical cancer were retrospectively analyzed. We compared pre-RT planning CT (n = 38) and intratreatment CBCT (n = 315), measuring cervical and corporal movement in each direction. Correlations between uterine movement and volume changes of the bladder and rectum on all CBCT scans were analyzed using Spearman rank correlation analysis. Relationships between the mean uterine movement and patient factors were analyzed using the Mann–Whitney test. The mean corpus movement was: superior margin (cranio–caudal direction), 7.6 ± 5.9 mm; anterior margin (anteroposterior direction), 8.3 ± 6.3 mm; left margin (lateral direction), 3.3 ± 2.9 mm; and right margin (lateral direction), 3.0 ± 2.3 mm. Generally, the mean values for cervical movement were smaller than those for the corpus. There was a significant, weak correlation between changes in bladder volume and the movement of the superior margin of the corpus (ρ = 0.364, P < 0.001). There was a significant difference in movement of the superior margin of the corpus between the subgroups with and without a history of previous pelvic surgery (P = 0.007). In conclusion, change in bladder volume and a history of previous surgery were significantly related to intrafractional corpus movement; however, our observations suggest that the accurate prediction of uterine movement remains challenging

Computed tomography–based image-guided brachytherapy for cervical cancer : correlations between dose–volume parameters and clinical outcomes

This study evaluated the oncologic outcomes and complications of cervical cancer patients in terms of CT-based image-guided brachytherapy (IGBT) parameters. Of 68 cervical cancer patients treated with definitive radiotherapy/concurrent chemoradiotherapy, most received whole-pelvis external beam RT (EBRT) of 40 Gy in 20 fractions, pelvic EBRT with central shield of 10 Gy in 5 fractions, and CT-based IGBT of 18 Gy in 3 fractions prescribed to point A. Cumulative EBRT and IGBT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). The median follow-up was 31 (3–52) months. The 2-year overall survival, local control, pelvic control, and disease-free survival rates of the 68 patients were 92%, 83%, 82% and 73%, respectively. The HR-CTV D90, length from the tandem axis to left/right margin of the HR-CTV (T-LR), and HR-CTV volume were significant IGBT parameters for predicting local/pelvic control. Patients who received an HR-CTV D90 of >60 Gy, compared with ≤60 Gy, had significantly better local/pelvic control. Furthermore, 70 Gy was a marginally significant HR-CTV D90 cut-off affecting local control. T-LR was an independent IGBT parameter predicting local/pelvic control on multivariate analysis. Three patients developed Grade 3 or higher treatment-related complications. The D2cm3 of organs at risk were not significant predictors of complications. Future challenges for further improving outcomes include additional interstitial needles for irregularly shaped HR-CTVs, and moderate dose escalation, especially for patients with poor tumor responses

Concurrent weekly cisplatin versus triweekly cisplatin with radiotherapy for locally advanced squamous-cell carcinoma of the cervix : a retrospective analysis from a single institution

Objective:To compare patients with cervical cancer who were primarily treated with concurrent chemoradiotherapy (CCRT) using 20 mg m^ CDDP for 5 days every 3 weeks with weekly regimens of 40 mg m^. Methods:We retrospectively analyzed 185 patients with Stage IB-IVA squamous-cell carcinoma of the cervix who were treated with CCRT between 2005 and 2013 at our hospital. The CCRT regimen consisted of cisplatin (CDDP) at 20 mg m^ for 5 days every 3 weeks or 40 mg m^ weekly, administered concomitantly with RT. Results:The median age was 50 years (range: 22-70 years) in the triweekly group and was 50.5 years (range: 28-70 years) in the weekly group. The 5-year overall survival rate in the triweekly and weekly groups were 82.0% and 83.3%, respectively (p = 0.851); their disease-free survival rate was 79.6% and 78.1%, respectively (p = 0.672). In the triweekly group, 56 patients (50.9%) had grade 3/4 leukopenia, which was significantly higher than that of 11 patients (15%) in the weekly group (p < 0.0001). Conclusion:The weekly CDDP regimen for CCRT seems better in patients with International Federation of Gynecology and Obstetrics Stages IB-IVA squamous-cell carcinoma of the cervix. Advances in knowledge: The weekly CDDP regimen for CCRT seems better in patients with International Federation of Gynecology and Obstetrics Stages IB-IVA squamous-cell carcinoma of the cervix

Appropriate radiation dose for symptomatic relief and local control in patients with adult T cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATL) is an aggressive peripheral T-cell neoplasm that occurs only in patients with human T-cell leukemia virus type 1. No large study or randomized trial investigating radiotherapy (RT) for ATL has been performed. We retrospectively reviewed 55 courses of RT for 41 consecutive patients with ATL who underwent RT between 2000 and 2016 at our institutions. The results showed that RT for local ATL lesions can achieve symptomatic improvement in 92% of cases. Local remission, either complete remission (CR) or partial response (PR), was achieved in 100% of the patients (CR: 89%, PR: 11%) with ≥40 Gy irradiation. CR or PR was achieved in 71% (CR: 29%, PR: 43%) with 30–39 Gy and in 73% (CR: 6.7%, PR: 67%) with ≤29 Gy irradiation. The mean total radiation dose in the CR and PR groups differed significantly (38 vs 25 Gy, P = 0.0002). The maximum acute toxicity was Grade 0–2 in all patients, except for one patient experienced Grade 3 radiation dermatitis. In-field relapses occurred in 36% of patients, and the frequency of in-field relapses was 11%, 30% and 71% among those who achieved CR, PR and SD, respectively. All 9 patients who received total skin irradiation experienced cutaneous relapses, with a median of 63 days (range, 7–210 days). Almost all (39 of 41) patients with ATL experienced out-of-field progression after RT. In conclusion, RT was confirmed to be effective and safe for palliative treatment of local ATL lesions