Abstract: Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility. Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us. Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m2 and irinotecan 82,5 mg/m2 injected directly into the circuit. Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition. Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted. Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.
Abstract: Introduction: treatment of patients with primary malignant neoplasms (PMN) of head and neck remains an unsolved problem. About 70% of neoplasms are unresectable, and one-year mortality rate reaches 90%. Aim: was to demonstrate possibilities of using the technique of isolated chemoperfusion of head and neck (ICPHN) developed by us in the experiment. Material and methods: ICPHN was performed using the method of extracorporeal membrane oxygenation (ECMO) on two non-human primates (hamadryas baboons), 20 kg males, 12–14 years old. The open version of intervention involved performing sternotomy, cannulation of brachiocephalic arteries (BCA) and superior vena cava (SVC) with their subsequent clamping after starting parallel ECMO. The endovascular version was made by overlapping the BCA and SVC with transfemorally inserted balloon catheters. Cannulation for ECMO was performed percutaneously through the axillary artery and vein. Perfusion was carried out for 30 minutes with a chemotherapy (CP) drug carboplatin at a dose of 150 mg injected immediately into the circuit. Results: both procedures were carried out successfully with good immediate and long-term (30 days of follow-up) results. After 10, 20 and 30 minutes from the moment of CP injection into the isolated circuit, its content in the circuit was 7-10 times, 3-3,5 times and 4-4,5 times exceeding the concentration in the systemic circulation, respectively. During the perioperative period, vital functions and laboratory parameters were within normal limits. No complications associated with both procedures were observed. All animals quickly recovered from anesthesia without signs of neurological disorders. Conclusions: the use of isolated chemoperfusion of head and neck with carboplatin in the experiment is feasible and safe. In the head and neck contour, the concentration of CP is observed, 3-5 times higher than in the systemic circulation, and that allows a more pronounced targeted effect on tumor. Taking into account the minimally invasiveness and repeatability of the procedure, the use of endovascular isolated chemoperfusion of head and neck is more promising. References 1. Vleeschouwer SD. Glioblastoma. Brisbane. Codon Publications. 2017; 678. 2. Maghami E. Multidisciplinary Care of the head and neck cancer patient. Springer International Publishing. 2018; 282. 3. Srinivasan VM, Lang FF, Chen SR, et al. Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors. J Neurointerv Surg. 2020; 12(2): 197-203. 4. Newton HB. Intra-arterial chemotherapy of primary brain tumors. Curr Treat Options Oncol. 2005; 6(6): 519-530. 5. Klopp CT, Alford TG, Bateman J, et al. Fractionated intra-arterial chemotherapy with methyl bis amine hydrochloride; a preliminary report. Ann Surg. 1950; 4: 811-832. 6. Creech O, Krementz ET, Ryan RF, et al. Chemotherapy of сancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958; 4: 616-632. 7. Woodhall B, Hall K, Mahaley S, et. al. Chemotherapy of brain cancer: experimental and clinical studies in localized hypothermic perfusion. Ann Surg. 1959; 4: 640-651. 8. Feind CR, Herter F, Markowitz A. Improvements in isolation head perfusion. Am J Surg. 1963; 5: 777-782.
