[Lipiodol with and without Gelfoam in primary liver tumors. Plasma levels of Mitoxantrone and clinical results].
Transcatheter chemoembolization with various drugs is employed for palliative treatment of hepatocellular carcinoma. Thirty-seven patients (33 with Child A or B cirrhosis) were treated with 14 mg/m2 of Mitoxantrone and up to 20 ml of Lipiodol, followed by Gelfoam embolization as indicated. Sixty-nine cycles were given, with mean (+/-SD) Lipiodol and emulsified Mitoxantrone doses of 11.3 +/- 3.8 ml and 11.8 +/- 5.2 mg, respectively. Thirteen, 16, and 8 patients received one, two, and three cycles, respectively, with time intervals of 123 +/- 60 days. Thirty patients had Gelfoam embolization at the first cycle, 9 at the second and 4 at the third. At the first cycle, 10 patients underwent serial measurements of serum Mitoxantrone up to two hours after a full dose of emulsified drug. Drug levels resulted much lower than those reported after plain arterial infusion, with AUC levels (+/-SE) of 5924 +/- 1015 and 4381 +/- 429 ng/ml x 120 min in 6 and 4 cases treated with and without Gelfoam, respectively. No treatment related deaths occurred. Complications were mild and transient, including nausea vomiting in most cases, fever > 38 degrees C 67%, pain 74%, ascites 8% jaundice 3%, bleeding 3%, pancreatitis 3%, myelosuppression 44%, diarrhea 5%. Treatment response rate was 49% (including 16% minor response) with 16% early progressions. With a median follow-up of 12 months, the 12-month response duration and survival rates were 56% and 79% respectively. Transcatheter chemoembolization with Mitoxantrone deserves further evaluation in randomized studies.
Civalleri
D
D
Istituto di Clinica Chirurgica B, Università degli Studi di Genova.
Esposito
M
M
De Caro
G
G
Borgonovo
G
G
De Cian
F
F
Mondini
G
G
Vannozzi
O
O
Bocchio
M M
MM
Carrabetta
S
S
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007459:Iodized Oil / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000627:therapeutic use*; D010166:Palliative Care; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003287:Contrast Media; D006490:Hemostatics; D007459:Iodized Oil; D008942:Mitoxantrone