title: Initial clinical experience with degradable starch microspheres.
abstract: Four patients with advanced hepatic malignancy have been investigated with a view to intra-arterial treatment with degradable starch microspheres (DSM) and mitomycin-C (MMC). Computer-assisted interpretation of data gathered during the administration of technetium-labelled albumin allows the degree of arteriovenous shunting within the liver to be measured. In a similar way, the effectiveness of DSM in blocking hepatic arterial flow is determined. Two patients showed unacceptably high levels of shunting (75% and 100%) and were excluded from further study. One patient with hepatocellular carcinoma shunted only 24% of the macroaggregated albumin, and flow through the liver was reduced to 48% by DSM therapy. This patient has undergone four courses of MMC without significant toxic complications. The last patient had 25% shunting. The DSM titration and the first MMC administration had to be abandoned because of severe abdominal pain and nausea related to a fracture of the intra-arterial catheter. Complications directly associated with the procedures have been acceptable. The relationship between flow reduction and the amount of DSM administered is non-linear, and the appropriate dose of DSM for each treatment must be titrated against both the patient's symptoms and the computer-generated flow indices.
authors.affiliation: Department of Medical Physics, Diagnostic Imaging, St James's University Hospital, Leeds, UK.
authors.forename: A I
authors.initials: AI
authors.lastname: Mavor
authors.forename: A
authors.initials: A
authors.lastname: Parkin
authors.forename: A
authors.initials: A
authors.lastname: Riley
authors.forename: S
authors.initials: S
authors.lastname: Smye
authors.forename: T
authors.initials: T
authors.lastname: O'Brien
authors.forename: P J
authors.initials: PJ
authors.lastname: Robinson
authors.forename: G R
authors.initials: GR
authors.lastname: Giles
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000628:therapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000627:therapeutic use; D013213:Starch / Q000008:administration & dosage*
chemical_list: D008937:Mitomycins; D016685:Mitomycin; D013213:Starch