title: Non-homogeneous intrahepatic drug distribution in intraportal infusional chemotherapy demonstrated by Tc-99m-MAA perfusion SPECT.
abstract: Perioperative adjuvant cytotoxic chemotherapy given through a portal vein catheter may reduce the incidence of metachronous liver metastases following curative resection of colorectal carcinoma. It has generally been assumed that positioning the tip of the catheter in the stem of the portal vein will ensure homogeneous drug distribution to the whole liver. This hypothesis has been put to the test in 10 patients receiving intraportal chemotherapy according to protocol 40/81 of the Swiss Group of Clinical Cancer Research. Catheter position in the stem of the portal vein was checked angiographically the first and last day of a 7-day chemotherapy course. Perfusion scans using 99m-Tc-MAA made during therapy were compared to static liver scans obtained with 99m-Tc sulfur colloid one day after conclusion of chemotherapy. The results were evaluated on planar scans and by SPECT. Slow infusion of the tracer substance under conditions duplicating those of cytotoxic drug infusion used in the protocol resulted in decreased or missing perfusion of the left liver lobe and gross non-homogeneous perfusion in nearly all of the patients.
authors.affiliation: Department of Surgery, Kantonsspital, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Aeberhard
authors.forename: A
authors.initials: A
authors.lastname: Bissat
authors.forename: C
authors.initials: C
authors.lastname: Koella
authors.forename: K
authors.initials: K
authors.lastname: Seybold
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage; D011169:Portal Vein; D013668:Technetium Tc 99m Aggregated Albumin; D014018:Tissue Distribution; D014055:Tomography, Emission-Computed
chemical_list: D008937:Mitomycins; D013668:Technetium Tc 99m Aggregated Albumin; D016685:Mitomycin; D005472:Fluorouracil