Abstract
Purpose
To develop an implantable port in which a microcatheter can be inserted for a combination therapy of repeated transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for advanced liver cancer.
Materials and Methods
The design of a currently used implantable port was modified. A funnel part was constructed in the port. The septum was punctured by a 20-gauge indwelling needle, and 2.0-Fr non-tapered microcatheter was inserted into the port. In the in vitro studies, the advance of a microcatheter out of the funnel part was evaluated via seven different septum puncture sites. A 5-Fr indwelling catheter connected to the port was placed in a vascular model, and a microcatheter catheterization was evaluated. In an in vivo study, the port–catheter system was implanted in the hepatic artery in a pig. A microcatheter was percutaneously inserted through the port into the hepatic arterial branches, and embolization was performed.
Results
In the in vitro studies, the microcatheter was smoothly advanced out of the port and catheterizations into the hepatic arteries were successful via all septum puncture sites. In the in vivo study, repeated selective embolization through the port was successfully conducted on 7, 14 and 21 days after the implantation.
Conclusion
The developed implantable port can be used for repeated catheter insertion into the hepatic artery. The combination of repeated TACE and HAIC could be possible using this device.
References
Mahnken AH, Pereira PL, de Baère T. Interventional oncologic approaches to liver metastases. Radiology. 2013;266(2):407–30.
Wang DS, Louie JD, Sze DY. Intra-arterial therapies for metastatic colorectal cancer. Semin Interv Radiol. 2013;30(1):12–20.
Arai Y, Inaba Y, Takeuchi Y, Ariyoshi Y. Intermittent hepatic arterial infusion of high-dose 5FU on a weekly schedule for liver metastases from colorectal cancer. Cancer Chemother Pharmacol. 1997;40:526–30.
Young S, D’Souza D, Flanagan S, Golzarian J. Review of the clinical evidence for the use of DEBIRI in the treatment of colorectal metastatic disease. Cardiovasc Interv Radiol. 2017;40(4):496–501.
Richardson AJ, Laurence JM, Lam VW. Transarterial chemoembolization with irinotecan beads in the treatment of colorectal liver metastases: systematic review. J Vasc Interv Radiol. 2013;24(8):1209–17.
Arai Y, Ohtsu A, Sato Y, et al. Phase I/II study of radiologic hepatic arterial infusion of fluorouracil plus systemic irinotecan for unresectable hepatic metastases from colorectal cancer: Japan Clinical Oncology Group Trial 0208-DI. J Vasc Interv Radiol. 2012;23(10):1261–7.
Nishiofuku H, Tanaka T, Aramaki T, et al. Hepatic arterial infusion of 5-fluorouracil for patients with liver metastases from colorectal cancer refractory to standard systemic chemotherapy: a multicenter, retrospective analysis. Clin Colorectal Cancer. 2010;9:305–10.
Chapelle N, Matysiak-Budnik T, Douane F, Metairie S, Rougier P, Touchefeu Y. Hepatic arterial infusion in the management of colorectal cancer liver metastasis: current and future perspectives. Dig Liver Dis. 2018;50(3):220–5.
Lencioni R, Aliberti C, de Baere T, et al. Transarterial treatment of colorectal cancer liver metastases with irinotecan-loaded drug-eluting beads: technical recommendations. J Vasc Interv Radiol. 2014;25(3):365–9.
Akinwande OK, Philips P, Duras P, Pluntke S, Scoggins C, Martin RC. Small versus large-sized drug-eluting beads (DEBIRI) for the treatment of hepatic colorectal metastases: a propensity score matching analysis. Cardiovasc Interv Radiol. 2015;38(2):361–71.
Mauri G, Varano GM, Della Vigna P, et al. Transarterial embolization with small-size particles loaded with irinotecan for the treatment of colorectal liver metastases: results of the MIRACLE III study. Cardiovasc Interv Radiol. 2018. https://doi.org/10.1007/s00270-018-2017-x.
Poursaid A, Jensen MM, Huo E, Ghandehari H. Polymeric materials for embolic and chemoembolic applications. J Control Release. 2016;28(240):414–33.
Tanaka T, Nishiofuku H, Maeda S, et al. Repeated bland-TAE using small microspheres injected via an implantable port-catheter system for liver metastases: an initial experience. Cardiovasc Interv Radiol. 2014;37:493–7.
Nishiofuku H, Tanaka T, Matsuoka M, et al. Transcatheter arterial chemoembolization using cisplatin powder mixed with degradable starch microspheres for colorectal liver metastases after FOLFOX failure: results of a phase I/II study. J Vasc Interv Radiol. 2013;24:56–65.
Tanaka T, Nishiofuku H, Hukuoka Y, et al. Pharmacokinetics and antitumor efficacy of chemoembolization using 40 µm irinotecan-loaded microspheres in a rabbit liver tumor model. J Vasc Interv Radiol. 2014;25(7):1037–44.
Sato T, Tanaka T, Nishiofuku H, et al. Pharmacokinetics and histopathological findings of chemoembolization using cisplatin powder mixed with degradable starch microspheres in a rabbit liver tumor model. Cardiovasc Interv Radiol. 2017;40(3):438–44.
Bavisotto LM, Patel NH, Althaus SJ, et al. Hepatic transcatheter arterial chemoembolization alternating with systemic protracted continuous infusion 5-fluorouracil for gastrointestinal malignancies metastatic to liver: a phase II trial of the Puget Sound Oncology Consortium (PSOC 1104). Clin Cancer Res. 1999;5(1):95–109.
Bhutiani N, Akinwande O, Martin RC 2nd. Efficacy and toxicity of hepatic intra-arterial drug-eluting (Irinotecan) bead (DEBIRI) therapy in irinotecan-refractory unresectable colorectal liver metastases. World J Surg. 2016;40(5):1178–90.
Iezzi R, Marsico VA, Guerra A, et al. Trans-arterial chemoembolization with irinotecan-loaded drug-eluting beads (DEBIRI) and capecitabine in refractory liver prevalent colorectal metastases: a phase II single-center study. Cardiovasc Interv Radiol. 2015;38(6):1523–31.
Tanaka T, Arai Y, Inaba Y, et al. Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J Vasc Interv Radiol. 2003;14:63–8.
Itano O, Itano S, Nagamatsu H, et al. Intermittent transcatheter therapy through a new indwelling catheter system for patients with hepatocellular carcinoma. Jpn J Radiol. 2014;32(11):670–5.
Acknowledgements
We thank Dr. Shunsuke Shimamura and Dr. Terumasa Shimada, Veterinary Medical Center, Osaka Prefecture University, for support in this animal study. We thank Ms. Marian Pahud for advice in submitting this article. This work was supported by Grant-in-Aid for Scientific Research (C), 15K09967.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflicts of interest and financial disclosures to declare.
Ethical Approval
All applicable institutional and national guidelines for the care and use of animals were followed.
Rights and permissions
About this article
Cite this article
Fukuoka, Y., Tanaka, T., Nishiofuku, H. et al. Development of Repeatable Microcatheter Access Port for Intra-arterial Therapy of Liver Cancer. Cardiovasc Intervent Radiol 42, 298–303 (2019). https://doi.org/10.1007/s00270-018-2111-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-018-2111-0