Abstract No. 172: Giant Renal Angiomyolipoma Embolization: Technique and Results

liver. Radio-embolization was performed using standard technique. Follow-up CT/MR and lab tests were obtained onemonth post Y-90. RESULTS: 8 patients have completed treatment, and 4 are awaiting Y-90 treatment. All are male, mean age 61.4 years. 7 are Child-Pugh A, and all have ECOG status 0 or 1. The mean AFP pretreatment was 1798 ug/L. 6 patients required sorafenib dose adjustment; the most common toxicities observed were GI (diarrhea) and hand foot syndrome. Toxicities occurred pre Y-90, and were generally self-limited and responded to dose adjustment. No patient required drug discontinuation or experienced grade 4 toxicity. AFP levels began to decrease on Sorafenib alone in 4 patients. The mean dose of Y-90 was 150 Gy. 1 patient experienced worsening ascites post-Y-90. 7 patients demonstrated tumor necrosis, and 4 had 100% necrosis. 5 had stable disease. 1 patient progressed after treatment (extrahepatic and contralateral liver). The mean decrease in AFP post Y-90 treatment was 1470 ug/L. More complete data will be presented at SIR 2009. CONCLUSION: These preliminary results demonstrate the safety and tolerability of combining Y-90 and Sorafenib in advanced HCC. 88% of patients demonstrated imaging evidence of necrosis. They continue to be followed to assess progression-free survival. Based on the encouraging tumor response and tolerability, a further Phase II study is planned. 5:36 PM

Abstract No. 170

Percutaneous Pelvic Stop-Flow Isolated Extracorporeal Perfusion (PPIP) for Loco-Regional Delivery of High Dose Chemotherapy: Technique, Feasibility and Early Results. A. Hakime, F. Deschamps, P. Rao, T. De beare; Gustave Roussy, Villejuif, France. PURPOSE: To study the feasibility of PIPP with high-doses of TNF-␣ and melphalan in patients with non resectable pelvic cancer. MATERIALS & METHODS: From may2004-december2007 seventeen patients with advanced pelvic cancer (4 pelvic sarcoma, 3 anal, 8 cervical, 1 vaginal and 1 rectal cancer) received PIPP under general anesthesia. One occlusion balloon was inflated in the terminal portion of the aorta upstream of the iliac bifurcation; a second balloon was inflated at the origin of the inferior vena cava. Balloon 17 to 23 mm in diameter were inserted through 9 to 11 French femoral percutaneous access. Pneumatic cuffs were inflated around the thigh, and a pneumatic anti shock garnments was placed over the trunk. TNFalpha 0,3mg and melphalan 1.5mg/kg were infused through an oxygenated extracorporeal circulation during 30 mn. Leakage was monitored by a radiolabeled TC99-serum albumin MRI after 2 months evaluates tumor response. RESULTS: Neither technical or hemodynamic complications, nor death occurred during the 30 post procedural days. Deep aplasia requiring transfusion occurred in 15/17 patients. Pelvic fistula were encountered in 5/17 patients. Exposure to the drug of the pelvis was 5 to 26 fold higher that systemic exposure. Five complete responses (complete necrosis), 7 major responses (⬎ 90% necrosis), partial responses (⬎ 50% necrosis), 1 stable disease and 1 progression were observed at two months. Survival after 6months was 86% CONCLUSION: PIPP allowed to obtained high of antineoplasic drug ratio from pelvic isolated circuit to systemic circulation agents with acceptable toxicity. The encouraging early clinical results with impressive tumor response suggest further evaluation. S66

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Abstract No. 171

Phase I Study of Transcatheter Arterial Chemoembolization with Cisplatin Powder and Degradable Starch Microspheres for Unresectable Hepatic Metastases from Colorectal Cancer. H. Nishiofuku1, T. Tanaka1, H. Sakaguchi2, K. Yamamoto1, S. Sueyoshi1, H. Anai1, M. Inoue1, M. Matsuoka3, T. Otsuji3, K. Kichikawa1; 1Nara Medical University, Kashihara-City, Japan; 2Nara Prefectural Mimuro Hospital, Ikoma-Gun, Japan; 3Dongo Hospital, Yamatotakada-City, Japan. PURPOSE: There is no active treatment for unresectable hepatic metastases from colorectal cancer after failure to oxaliplatin and 5-fluorouracil. We conducted new transcatheter arterial chemoembolization with cisplatin powder and degradable starch microspheres (DSM), and a phase I study to determine the dose limiting toxicity (DLT), maximal tolerated dose (MTD) and recommended dose (RD) was presented. MATERIALS & METHODS: Eligibility criteria included unresectable colorectal hepatic metastatic lesions that could be measured in one dimension, according to the Response Evaluation Criteria in Solid Tumors (RECIST), after failure to standard chemotherapy using oxaliplatin and 5-fluorouracil, ECOG PS 0-2, and normal organ and bone marrow function. A catheter was inserted into hepatic artery. Cisplatin powder and DSM (300mg) mixing solution was infused. Injection of DSM without cisplatin powder was added until the stasis of arterial flow. Cohorts of 3 patients received escalating dose of cisplatin (50mg/m2, 65mg/m2 and 80mg/m2). Toxicity was assessed according to the CTCAE (ver. 3.0) during first cycle of chemoembolization. RESULTS: No DLT was observed at each dose of cisplatin, 3 patients received cisplatin with 50mg/m2, 3 with 65mg /m2 and 3 with 80mg/m2. Grade 3 or more toxicities were not observed in all cohorts. According to the RECIST criteria, the overall therapeutic response was 0 with complete response, 3 with partial response, 5 with stable disease and 1 with progression disease, respectively. Response rate was higher according to the escalation of the dose of cisplatin, and that of the group with 80mg/m2 was 66.7%. CONCLUSION: MTD was not yet reached in this study. Cisplatin 80mg/m2 was recommended for a phase II study. Phase II study is now ongoing at 80mg/m2 of cisplatin.

Scientific Session 18 Vascular Interventions: Embolization (Non-oncology) Tuesday, March 10, 2009 4:00 PM - 6:03 PM Room: 17A 4:00 PM

Abstract No. 172

Giant Renal Angiomyolipoma Embolization: Technique and Results. V. Bishay, S.W. Stavropoulos, M.C. Soulen, A.J. Wein, S.B. Maldowicz, S.O. Trerotola, P. Crino; University of Pennsylvania, Philadelphia, PA. PURPOSE: While selective arterial embolization is an accepted treatment option for patients with renal angiomyolipoma (AML) over 4 cm, embolization of very large AMLs

poses unique challenges and risks. This study was conducted to evaluate the efficacy and safety of prophylactic embolization of AMLs over 10 cm in size. MATERIALS & METHODS: 16 consecutive patients (mean age⫽41.2; 14 females, 2 males) underwent embolization for 23 AMLs 10 cm or larger. 12 (75%) patients had tuberous sclerosis. All lesions were embolized using high flow microcatheters with ethanol (ETOH) and ethiodized oil (EO) mixed to a ratio of 7(ETOH):3(EO). Data that were retrospectively collected from the medical records and a QA database with IRB approval included pre and post treatment AML size and creatinine, technical success, volume of embolic material used, clinical success and complications.

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Abstract No. 173

Endovascular Repair of Vascular Complications Following Caesarian Section. C. Fan, D. Pyne, R.A. Baum, M.S. Stecker, A.K. Chun, S.K. O’Horo, M.P. Schenker, A.S. Han; Brigham and Women’s Hospital, Boston, MA. PURPOSE: The purpose of this investigation is to review the types of postpartum vascular injuries associated with caesarian section surgery and to review the techniques and outcomes of endovascular treatment. MATERIALS & METHODS: This is a retrospective review of women who underwent endovascular treatment for vascular complications following C-section delivery at a single institution from 1/1/05 to 10/1/08. All imaging was reviewed along with clinical parameters, including patient age, prior pelvic surgery, time of presentation after Csection, type of vascular injury, type of endovascular treatment, and post-endovascular treatment clinical course. RESULTS: Thirteen women underwent endovascular treatment for postpartum hemorrhage following C-section during the time period specified. Mean age was 35.3 years old (range 28-44). Severity of bleeding ranged from mild (⬍500cc) to severe hemorrhage (⬎3000cc). Mean pre-embolization transfusion requirement was 3.2 units PRBC’s (range 0-6). Five subjects had positive angiographic findings, including two pseudoaneurysms and three active arterial extravasations; in

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Abstract No. 174

Effectiveness of Preoperative Embolization of Osseous Tumors (PEOT) Using Microspheres Versus Non-Microspheres in Reducing Intraoperative Blood Loss: A Retrospective Evaluation of PEOT in 3 Years at a Single Institution. C. Chen, E.W. Lee, C.T. Loh, C.H. Hoffman, S.T. Kee; UCLA Medical Center, Los Angeles, CA. PURPOSE: 1. To evaluate the effectiveness of PEOT with trisacryl-gelatin microspheres (TM) versus non-microspheres (NM) in reducing intraoperative blood loss (BL). 2. To examine differences in post-surgical complication rates between TM and NM. MATERIALS & METHODS: Upon IRB approval, the Interventional Radiology database was reviewed to retrieve all patients who underwent PEOT between 01/2005 and 01/ 2008. Details of patient demographics, site of primary tumor, bone tumor characteristics, angiographic findings, time interval between PEOT and surgery, intraoperative BL and post-surgical complications were recorded. RESULTS: A total of 29 PEOTs were performed in 26 patients. 14 patients received TM and 12 received a combination of polyvinyl alcohol and coils (NM). The average age in TM and NM groups were 61.3 and 60 years, respectively. Majority of bone tumors were metastases from renal cell carcinoma (36% vs. 58%, TM vs. NM), followed by hepatocellular carcinoma (28% vs. 0%). Both groups shared a similar average tumor volume (6.3x5.1x2.5cm3 vs. 5.7x4.0x2.3cm3). The most targeted sites of PEOT with TM vs. NM were the proximal femur (50%) and vertebral spine (61.5%), respectively. On average, surgeries occurred 1.75 and 2.7 days (TM vs. NM) after PEOT. The least amount of average BL (258mL) was observed in TM patients with ⱖ 95% obliteration in tumor blush post-PEOT, while the most blood was lost in TM patients with ⬍ 95% tumor blush obliteration (600ml). NMs were associated with intraoperative BL of 356 and 425mL when tumor blush was reduced by ⱖ95% and ⬍95%, respectively. In terms of complication rates, a higher rate of tumor recurrence was observed with NM (25% vs. 7%). No neurological complications were reported in either group. CONCLUSION: 1. TM is superior to NM in reducing intraoperative BL when complete embolization is achieved. 2. PEOT with TM is safe and effective and is associated with S67

TUESDAY

CONCLUSION: Embolization of giant renal AMLs to decrease the risk of bleeding can be done safely without significant loss of renal function. Although recurrence was infrequent, additional treatment may be necessary and all giant renal AMLs should be followed with life-long serial imaging studies.

CONCLUSION: Vascular injury during caesarian section delivery is an uncommon event that can result in significant bleeding, presenting immediately or up to several weeks after delivery. Pseudoaneurysms in particular tend to have a delayed time of presentation. Overall, regardless of clinical circumstances, hemorrhage following C-section can be embolized promptly and effectively with minimal post-embolization complications.

Scientific Sessions

RESULTS: Mean pre-treatment AML size was 15 cm (range, 10-25 cm). Embolization was technically successful in all cases. 10 (62.5%) patients had all their AMLs treated in one session, while 6 (37.5%) required multiple sessions. A mean volume of 8.6 mL of the ETOH/EO mixture was administered (range, 2-20 mL) per lesion. Patients were followed for a mean of 26 months (range, 1 - 66). Mean follow-up AML size was 13.8 cm (8% decrease from preembolization). 2 (12.5%) patients required repeat embolization due to AML re-growth (n⫽1) or re-perfusion (n⫽1) seen on surveillance imaging 37 and 47 months after the initial treatment. One (6.3%) patient developed a clinically significant bleed 59 months after AML embolization. This required ICU hospitalization and an emergent repeat embolization. Complications following treatment occurred in 2 patients (12.5%), including a pneumothorax in one patient and a UTI in another. No patients experienced a significant (over 0.2 mg/dl) rise in serum creatinine.

the remaining 8 subjects, no arterial bleed was found and prophylactic uterine artery embolization was performed to control presumed venous bleeding or vasospasm masking arterial bleeding. Onset of postpartum hemorrhage ranged from immediate to 16 days post C-section, with 9 of the 13 (69%) women presenting within 24 hours; however, both pseudoaneurysms presented after one week. Embolization agent choice included one hypogastric artery balloon occlusion, 2 coil embolizations, and 10 gelfoam embolizations. Mean post-embolization transfusion requirement was 0.45 units PRBC’s (range 0-4) and mean length of stay after embolization was 5.2 days (range 1-12 days).