Scientific Session 13 Oncologic Interventions: Regional Tumor Therapy Techniques

ameter, and supraceJiac diameter were measured at equivalenr levels on serial CT's. The change in diameter and length at all levels was calculated. RESULTS: The mean time intelval between serial CT's was 51.0 months (range 10-156 months). The mean baseline AAA D = 3.91 cm, L = 5.95 cm; mean AAA change D = + 0.9 cm, L = + 1.6 cm. The mean baseline infrarenal neck D = 25.8 mrn, L = 26.0 nun; mean neck change D = + 2.9 mrn (p = 0.003), L = - 7.1 mm (p = 0.0002). The mean baseline suprarenal D = 26.9 mm, change D = + 0.7 mm (p = 0.02). The mean baseline supraceliac D = 29.5 mm, change D = + 0.9 mm (p = O.OI). CONCLUSION: In the untreated AAA, rhe infrarenal neck shortens and Widens, the suprarenal and supraceliac aonic diameter remains more constant with time. These changes may influence rype and location of proximal endograft fixation pOints. The mean infrarenal neck diameter is in excess or at the upper limit of acceptable diameter for currently available endografl devices. 4:32 pm

Abstract No. 96

from endoleak rates are .30/0, 81.2% and 75.6% at 1,2 and years of follow up respectively. CO CL '10: M t death occurring at follow up are not r lated. Ruptur ha e 0 curl' d, 'orne relat d 10 primary proximal type I cndoleak. thers may be relat d to econdary endoleak ' that have not been dele led. Late complications related to the device or AAA occur at a rate of ab ut 10% per year. Mo t freqi.lently the e are new eodoleak e.g stump di location r graft or limb ocelu ions. Mo tare amenablt' to cndova 'clilar lreatment, but recurrence may 0 ur. 0 continued surveillan e i nec my.

Scientific Session 13 Oncologic Interventions: Regional Tumor Therapy Techniques Moderator: Jeff Geschwind, MD

Tuesday, March 6,2001 1:30 pm-3:00 pm 1:30 pm

Midterm Follow up on 1000 Patient on the UK Registry of Endovascular Treatment of Aneurysms (RETA). S.M. Thomas, bf1Jield Vas It/ar Il1Slilule, Shifjle/d, United Killgdom • PA. Gaines • jD. Beard

PURPOSE: To pr em tbe midterm follow up .of patient on RETA. MATER1AlSANDMETHOD : RETA now ha a cohort

of 1000 registered patients. Follow up is availahle for: 4 3 cases at one year ( _.6% follow up rate); 191 case at two years 85.2% follow up rale) .and 64 cas(;,; al three y ars 76.3% follow up rale)

RE UL1 : The mottality rate ar 10.8%, 12.6% and 6.3~1l at 1, 2 and 3 year fotlow up respecti\'dy. The majority of d arhs at follow up ar unrelated to the endovas ular aneur}' m repair. Howe\-er, i'upturcs havl: occurred with 'i (l %) DC urring in the fir t year of follow up and 3 (1.6%) l' pon d in the s nd year of foHow up. This gives a cumulalive ri k of rupture of 1.05!-{) at lyr and 2.65% at 2 and 3 years. 3 of the ruptures had per-i ting primary prOXimal endoleak and 2 had documented econdary endoleaks. Complication related to th anewy m or devie c urred in 11.1%, J~. % and 12. Vo of cases at 1,2 and 3 year follow up. The commone t problems are secondaly endoleaks, though mo t of these had 'ue e ful endova 1Iiar treatment. rraft or limb OCelli ions are the next mo t ommon problem . Foil w up on 'econdary pro dure. having ndova 'ular treatment uggest Lh se tr atment are durable, though the number' are at present small. The cumulativ endol ak fre sUlvival rates are 73.4%, 57.9% und 49.9% and the cl.lml.llativ freedom

Abstract No. 97

Portal Vein Embolization using Polyvinyl Alcohol and Coils in Preparation for Major Liver Resection in Patients with Advanced Hepatobiliary Malignancy. D.C. MadojJ, The UniVersity o/Texas M.D. Anderson Cancer Center, Houston, TX, USA • ME Hicks • A.G. Encamacion • IN. Vauthey

PURPOSE: To evaluate the safety and utility of preoperative portal vein embolization (PVE) in patients with advanced hepatobiliary malignancy scheduled to undergo right lobectomy or right trisegmentectomy. iV1A7ERlALS AND ME1HODS: From 10/98 to 9/00, PYE

was performed in 18 patients (13M,5F; mean age 59y). All patients had malignant disease: metastases (n=8); cholangiocarcinoma (n=7); hepatoma (n=2); gallbladder carcinoma (n=I). No patient had underlying liver disease. PYE was performed if future liver remnant (FLR) was estimated to be <25%. Of 18 PYE, 17 were performed via a right percutaneous rranshepatic approach. Polyvinyl alcohol (PVA) particles and coils were used to occlude the right portal system (n=18) and veins supplying segment 4 (n=15) to promote hypertrophy of rhe FLR (segments 1,2,3, ± 4). CT scans 2-4 weeks after PYE were used to determine FLR hypertrophy. RESULTS: Ten patients underwent hepatic resection (right trisegmentectomy (n=9), Whipple procedure with right lobectomy (n=1) without incident. Five patients were not resected (2 due to lack of regeneration; 3 had extrahepatic disease undetected at time of PVE). Three patients awail resection. Five patients had biliary obstruction treated percutaneously prior to PVE. No patient developed post-embolization syn-

839

drome (pain,fever,vomiting) or signs of liver insufficiency (post-PVE/post-resection). Two patients had complications following PVE that did not preclude successful resection: portal vein thrombosis in patient with accessory lefL ponal vein treated successfully with thrombolysis (n=1); subcapsular hematoma (n=1). Median hospital stays were 1 day (range 0·7 days) For PYE and 7 days (range 6-16 days) For liver resection. Mean absolute FLR increased from 274 to 408 cm' (49%). CONCLUSION: PYE using PYA and coils is a safe and effective method for preparing patients with advanced hepatobiliaIY malignancy for major liver resection and does not cause the post--embolization syndrome often associated with hepatic arteIY embolization.

Abstract No. 98 Transcatheler Hepatic Arterial Chemoembolization for Hepatocellular Carcinoma Invading Po~l Veins: PrognostJc Factors. j. Uraki, Mie University, School ofMedicine, Tsu, japm'l • K. Yamakado • A. Nakatsuka • N. Tanaka. A. Fujii • K. Takeda

PURPOSE: To evaluate a clinical efficacy and prognostic factors of transcatheter hepatic arterial cheemoembolization(TACE) on hepatocellular carcinoma (HCC) invading portal veins(PVs). MATERiALS AND MEIHODS.· fifty patients with HCC invading PVs underwem TACE. HCCs invaded main PVs in 22 patients, first order PVs in 17 patients, and second order PVs in 11 patients, .respectively. Hepatic arteries feeding tumors were embolized with gelatin sponge after a mixture of iodized-oil and anticancer drugs was injected into thee arteries. 1n 19 patients, repeat hepatic alterial infusion chemotherapy was combined eithcr before or aftcr TACE.

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Abstract No. 99 Investigation of Hepatic Intra·arterial Delivery of Doxorubicin Hydrochloride Adsorbed to Magnetic Targeted Carriers in Patients with HepatoceUular Carcinoma. S.c. Goodwin, UClA Medical Center, Los Angeles, CA. USA • R. Gordon. R. Kerlan • E. \\'lalser

PURPOSE- Determine the safety, maximum tolerated dose (MID), and pharmacokinetic profile of doxorubicin hydrochloride adsorbed to magnetic targeted carriers (MTC-OOX) administercd by hcpatic intra-arterial delivery under magnetic guidance in patients (prs) with hepatocellular carcinoma. Obtain preliminaIY tumor re· sponse data in treated patients. MATERIALS AND ME17JODS, Catheterization of the hepatic artery was done for delivery of doxorubicin adsorbed to MTC-DOX. An external magnet was positioned over the tumor during infusion of MTC-DOX. Samples were collected for pharmacokinctic analysis and an MRI was done to determine the location of the MTCs. Pts werc cvaluated over 28 days for clinical status, hematology, and serum chemistlY tests. CT scan measurements of tumor size were taken at baseline and at 28 days as a preliminary measure of tumor response. RESUlTS: 21 patients have completed the trial, and targeting of MTC-DOX was achieved in 19/21 patients. Doses of 36 mg of DOX have been localized without reaching the MTD. Pharmacokinetic measurements show no evidence of drug in systemic circulation. The most common adverse events have bcen abdominal pain (76%) and nausea (47%). A range of tumor sizes was treated (cross-sectional arcaS of 4 to 222 cm 2). The calculated amount of MTC-DOX localized to tumor ranged from 0.01 to 6.0 mglcm2 DOX. Preliminary response data (NC1 criteria) in 10 pes treated at doses> 0.2 mglcm 2 have becn 1 progressive, 5 stable, 2 minor, and 2 paltial responses. 1n one of the responses categorized as stable, CT scans showed no arterial enhanccment indicative of complete tumor necrosis. CONCLUSION, SaFelY and tOlerability of MTC-DOX through 36 mg of doxorubicin have been investigared. Drug is believed to be localized within the tumor as evidenced by absencc of systemic levels. Dosing based on Lumor size C~:=O.5mg DOXlcm 2) is under invcsLigalion.

RF.SUl7S: TACE was performed 103 times (mcans, rwicc per paticnt). TACE was successfully performed without major complications except one patient who developed fatal liver failure. The 1-, 2-.' 3--, and 4~year survival rates were 36%, 20%, 100A>, and 7%, respectively with a mean survival period of 13.3 months in all patients. Staging (Okuda classification) and type of tumor were significant prognostic factors by univariate analysis. By multi· variate analysis, only type of tumor was a significant prognostic factor. Thc mean survival was 23 months in 11 patients haVing nodular-type HCC and 10 months in 39 patients having diffuse-type HCC. The degree of portal vein invasion was not a significant prognostic factor.

Treatment of Radioresistant Head and Neck Squamous ceu Carcinomas (HNSCC) with Superselective Intra-arterial Infusion of Platino!. DM. Coldwell, Un.iversity ofMaryland, Baltimore, MD, USA • D. VanEcho • R. Murthy. R. Boyd-Kranis • C.S. Hastings. D. Radack

CONCLUSION: TACE is safe and effective in the treatment of HCC invading portal veins. Type of tumor is the most important factor for prognosis.

PURPOSE To determine the safety and efficacy of superselective infusion of Platinol for the treaunem of previously maximally treated HNSCC.

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Abstract No. 100

MATERIALS AND ME7HODS: Patients with unresectable HNSCC who had received the Rad-Plat protocol delivering Platinol as a radiosensitizer followed by radiation up to 100 Gray with the tumor either growing while the treatment was progressing or recurring after the treatment was completed were enrolled. Platinol 75 mg/m2 was then infused every two weeks into the most superselective position which allowed the coverage of all the tumor. Follow-up CT scans were obtained at monthly intervals for 6 months and then at 3 month intervals. Symptoms were recorded and graded pre and post-proceduraJly. RESULTS: 12 patients (7 men, 5 women) were enrolled. Mean age was 58 (range 38-80). Presenting symptoms were enlarging tumor after radiation, pain, hemorrhage. Patients had anaverage of 2 infusions (range 1-4). Follow-up was a mean of 6 months (range 2-15). Complete response with irradication of all disease occurred in 4/12 (33%). Partial response in 3/12 (25%) and stabilization of disease in 3/12(25%). Progressive disease occurred in 2/12(17%). Symptoms were eliminated in 10/12(83%). Toxicities included pain in the dermal distribution of the facial artery (1 patient) and transient elevation of the creatinine (3 patients). CONCLUSION: Superselective infusion of Platinol is a safe and effective treatment for unresectable previously maXimally treated HNSCC.

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Abstract No. 101

Femoral Dual Catheterization for Multidetector CT-Hepatic Angiograms: Precise Decision-making on Chemoembolization of Hepatocellular Ca.rdnoma. A. Sana, Temoj Hospital, Tenn, Japan • T Taniguchi • A. Httmanaka • M. Kil'ihara • R. Kawasaki. Y. Fushimi, et at. PURPOSE: To evaluate safety and utility of dual catheterization via a newly designed two-way femoral sheath in order to facillitate CT-hepatic angiograms including CT-heptic arteriogram (CTHA) and CT-arterial portogram (CTAP) for the decision-making on chemoembolization of hepatocellular carcinoma (HCC). MATERIALS AND ME7HODS: Forty consecutive patients with HCC, 29 men and 11 women aged 43-80 year with 65.5 year mean age, underwent CT-hepatic angiograms with femoral dual catheterization. In order to facillitate a set of CT-angiograms taken by a helical or multidetector CT scanner, 7F femoral two-way valve sheath was used to accept both 4F selective hepatic catheter for CTHA and 3F SMA catheter for CTAP. The whole system of femoral dual catheterization was evaluated in terms of safety and utility. In addition the detectability of hepatic mass was studied in 103 HCCs smaller than 3cm in diameter, pathologically-proved and Lipiodol-accumulated, by comparing CTHA, CTAP and DSA hepatic arteriograms (DSAHA).

RESULTS: No technical hazards were encountered either in dual catheterization or in selective catheter manipulation. All of CT images were well documented except for two patients who failed CTAP because an SlVlA catheter was drawn back to the aorta during transportation of patiems to CT-suite. Hepatic masses were detected in 99% on CTHA, 95% on CTAP and 76% on DSAHA of 103 proved HCCs smaller than 3cm in diameter, and further in 97% on CTHA, 91% on CTAP and 46% on DSAHA of 35 HCCs smaller than lcm. CONCLUSION: Dual catheterization via femoral twoway valve sheath is a useful method facillitating CT-angiograms without any technical hazards. The system allows to safely obtain a set of CTHA and ClAP, which is advantageous to detection of smail HCCs and practically contributable to precise preprocedural decision-making on chemoembolization of HCC. It is concluded that target tumors of HCC and hepatic arterial branches to be embolized should be assessed with CT-hepatic angiograms, not with DSA aneriograms.

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Abstract No. 102

Transcatheter Arterial Chemoembolization for Recurrent Hepatocellular Carcinoma after Liver Transplant: 100% 12-month Survival E.R. Balzano, University ofPittsburgh, Pittsburgh, PA. USA • A.B. Zajka • B.I. Carr • N.B. Amesur • PD.Orons PURPOSE: To evaluate the safety, response, and survival after transcatheter arterial chemoembolization (TACE) in patients with transplanted livers who developed recurrem cancer. To our knowledge, there are no reported data on the use of TACE in the transplanted liver. MATERIALS AND ME7HODS: Eight patients with malig-

nancy in their explanted livers [hepatocellular carcinoma (HCC), n=7; neuroendocrine cancer (NEC), n=11 were found to have recurrent cancer in their transplanted livers on follow-up computed tomography (CT). The recurrences were detected between one and 74 months after liver transplant with an average of 28 months. All were biopsy proven. HCC was treated with cisplatin and NEC with adriamycin. All patients received gelfoam embolization with the chemotherapy infusion. Between four and twelve cycles of TACE (average, 8.6 cycles) were administered. TACE was repeated every 6 to 8 weeks and abdominal CT was performed before each treatment. RESULTS: Based on CT, two of the eight patients (25%) had complete tumor response, two patients (25%) showed no change, and four patients (50%) had tumor progression. The cumulative survival was: lOOOAJ at 1 yr., 43% at 2 yrs. and 29% at 3 yrs. Two patients remain alive, one at 45 months (NEC), and one at six months. The median survival for the six HCC patients who died was 22 months. CONCLUSION: Patients with recurrent HCC or NEC after liver transplant have few options for treatment. 'fACE is

841

a safe therapy in our experience. 50% of these patients demonstrated either tumor response or disease stability.

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Abstract No. 103

Radiofrequency Induced Thermal Ablation (RITA) of Primary and Metastatic Liver Tumors: Results in 90 Consecutive Patients. A. Veltri, University of Turin (Italy), Turin, Italy· P Hosseinollahi • F Barisone • D. Campanella • M. Gallizioli • G. Gandini PURPOSE: To evaluate the mid-term results of RITA in hepatic tumors. MATERIALS AND METHODS: Between March 1996 and August 2000, we treated 33 patients with HCC and 57 with metastases; the metastases were from colon cancer (45 pts), breast cancer (4 pts), and other tumors (8 pts). One-hundred-forty-six RITA sessions 035 percLltaneous, 11 intraoperative; 124 "simple", 22 combined with TACE, arterial or portal stop-flow, or Pringle maneuvre) were performed in 137 lesions 0-9 per patient, mean 1.5; size 10-80 mm, median 27 mm); particularly, 24/41 HCC were residual lesions after PEL The local results were first evaluated by CT; the patients were then fulloweJ-up clinically and by US/CT. RESULTS: Adverse events (no mortality) occurred in 10% patients (4% in simple treatments, 18% in combined procedures). Early CT-study showed complete necrosis in 105/137 (77%) lesions, but during the follow-up 0-54 months, mean 15 months) lasting local control was achieved only in 84/137 (61%: 67% in metastases; 49% in HCC overall, 71% in not previously treated nodules); causes for recurrence were larger size and partial fibrosis in residual HCe. Up to now, 97% HCC and 72% metastatic patients are still alive, but only 29% are disease free (28% HCC pts and 30% metastatic pts). Higher mid-term survival rate of HCC was probably due to the slower natural course of the disease. [n metastatic patients, RITA was combined with other antitumoral therapies in 74% patients and followed by tumor recurrence in the same or in other site in 58%; so, only 140/0 are alive and disease free without other therapies after one year. CONCLUSION: RITA is relatively safe and quite effective in obtaining local control of primary and metastatic liver tumors; its clinical success depends on patients selection and other integrated oncologic therapies.

(RFA) of soft tissue neoplasms, and to describe methods to avoid complications in specific clinical settings. SUB]ECTS AND METHODS: Percutaneous image-guided RFA treatment sessions were performed on 150 tumors in 70 patients over 24 months. Tumor histology included melanoma, ovarian carcinoma, fallopian tube carcinoma, hepatocellular carcinoma, sarcoma, colon carcinoma, adenocarcinoma of unknown origin, pheochromocytoma, renal cell carcinoma, adrenocortical carcinoma, neuroendocrine, insulinoma, and osteode osteoma. Tumor locations included liver, kidney, axilla, flank, back, paraspinal muscles, suprarenal, renal hilum, adrenal, groin, adnexa, perirectal pelvis, pericolonic gutter, rib, pleura, spleen and vertebral body. Treated tumors abutted vital structures, including colon, rectum, small bowel, gallbladder, stomach, spleen, pancreas, lung, diaphragm, kidney, bladder, vagina, brachial plexus, aSCites, aorta, renal vein, ureter, celiac artery, common femoral artery, common femoral vein, main hepatic vein, main portal vein, inferior vena cava, and right atrium. RESULTS: All patients went home or were off service from 6 to 23 hours after the procedure without major complication. The treatment margin included non-target organs in several cases. One patient with a nearby colostomy had a delayed wound infection, and one patient had transient weakness in leg extension. Five pleural effusions were noted, one of which requi.red pleurodesis. Methods of protecting non-target organs included ice bags, pro-peristaltic drugs, chilled enema, bladder emptying, paracentesis, intraprocedural neurological exams, and appropriate sedation, analgesia, or anesthesia, as well as intraprocedural temperature monitoring. CONCLUSION Percutaneous, image-guided RFA can be a safe and well-tolerated procedure. Proximity to vital organs should not be an absolute contraindication to percutaneous RFA. However, simple precautions may minimize the risk of complications.

Scientific Session 14 Endovascular Repair of Abdominal Aortic Aneurysms: Endoleaks Moderator: Brian Stainken, MD

Tuesday, March 6, 2001 1:30 pm-3:00 pm 1:30 pm

2:47pm

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Abstract No. 104

Abstract No. 105

Avoiding Complications in Radiofrequency Tumor Ablation. Bj. Wood, National Institutes ofHealth, Bethesda, MD, USA • I. Mikityansky • C. Pavlovich • R. Chang • M. Walther· S. Libutti, et at.

Association of Coumadin Therapy and Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysm. J.D. Goodman, UCSF, San hancisco, CA, USA • }.M. LaBerge • TA. Chuter • L. Reilly· R. Sawhney • R.K. Kerlan, et at.

OB]ECITVE: To assess the safety and potential complications of outpatient percutaneous radiofrequency ablation

PURPOSE: EndoJeaks are encountered in up to 45% of patients following endovascular repair of abdominal