Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in gastrointestinal cancer patients with massive ascites treated with systemic chemotherapy

Nagata, Yusuke; Kato, Ken; Miyamoto, Terumasa; Hirano, Hidekazu; Shoji, Hirokazu; Iwasa, Satoru; Honma, Yoshitaka; Takashima, Atsuo; Hamaguchi, Tetsuya; Matsushita, Hiromichi; Nagashima, Kengo; Saruta, Masayuki; Boku, Narikazu

doi:10.1007/s00520-020-05401-4

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…A total of 2567 patients with MRA and 6013 procedures of CART were identified [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] ( Table 1 ). All studies were conducted in Japan.…”

Section: Resultsmentioning

confidence: 99%

“…The combination of CART and antineoplastic agents was proven to be as safe as CART alone in cases of MRA [ 36 ]. CART may contribute to improved survival in patients with advanced gynecological and gastrointestinal cancers [ 26 , 29 ]. The combination of CART followed by chemotherapy could be a treatment option for cancer patients with MRA.…”

Section: Discussionmentioning

confidence: 99%

“…Nine studies used 100 or 200 mg of hydrocortisone before reinfusion to prevent fever during reinfusion, but an increase in body temperature was observed, at an average of 0.4 °C (95% CI 0.18- An improvement in PS was reported by 10 studies. Due to different evaluation methods, only four studies were included in the meta-analysis, showing that 17% (95% CI 3-31%) of the patients had improved PS after CART [24,26,27,29] (Supplementary Figure S10). Most studies also described the alleviation of symptoms after CART, with abdominal distension, dyspnea, and fatigue improved 6.0 (95% CI 5.59-6.51), 2.66 (95% CI 2.05-3.28), and 2.64 (95% CI 1.86-3.42) points using a numerical rating scale system ranging from 0 to 10 (Table 2) [18,25].…”

Section: Adverse Events In Cartmentioning

confidence: 99%

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Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Hao

Ishihara

Horita

et al. 2021

Cancers

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Background: Malignancy-related ascites (MRA) is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one of the palliative treatments widely conducted in Japan only. Methods: A systematic review following a meta-analysis of CART was performed. The efficiency and adverse events were evaluated. Results: A total of 2567 patients and 6013 procedures of CART were identified in this study. The mean volume of MRA collected was 4.29 (95% confidence interval (CI) 3.47–5.11) L, and the volume reinfused after concentrating was 0.49 (95% CI 0.39–0.60) L. A total of 86.1 (95% CI 77.1–95.2) g protein and 42.9 (95% CI 36.0–50.0) g albumin was reinfused. The mean time to the next paracentesis was 20.7 (95% CI 15.6–25.8) days. The body weight was reduced by 3.38 (95% CI 1.90–4.86; p < 0.01) kg, and abdominal circumference was reduced by 7.86 (95% CI 6.58–9.14; p < 0.001) cm. Serum albumin increased an average of 0.14 (95% CI −0.01–0.28; p = 0.07) mg/dL the day after CART. Abdominal distension, dyspnea, and fatigue were alleviated by 6.0 (95% CI 5.59–6.51), 2.66 (95% CI 2.05–3.28), and 2.64 (95% CI 1.86–3.42) points using a numerical rating scale system ranging from 0 to 10. Overall, 17% (95% CI 0.03–0.31%) of patients had improved performance status after CART. Significant body temperature elevation was observed, at an average of 0.4 °C (95% CI 0.18–0.62 °C). Conclusions: CART might be a safe and effective palliative therapy in MRA and further clinical trials are necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Adverse Events In Cartmentioning

confidence: 99%

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Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Hao

Ishihara

Horita

et al. 2021

Cancers

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“…Performing CART prior to surgery would prevent albumin loss during surgery and save albumin preparations. In gastrointestinal cancer patients with massive ascites, the efficacy and safety of the combination of CART followed by chemotherapy have been reported 20 …”

Section: Discussionmentioning

confidence: 99%

Quality of life assessment of cell‐free and concentrated ascites reinfusion therapy during initial treatment for advanced ovarian cancer: A prospective cohort study

Yamamoto

Nagao

Tsu

et al. 2021

J of Obstet and Gynaecol

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Aim Cell‐free and concentrated ascites reinfusion therapy (CART) is applied to relieve symptoms in patients with malignant ascites. We performed a prospective cohort study to evaluate the efficacy and safety of CART performed on patients with advanced ovarian and peritoneal cancers with massive ascites during the initial treatment. Methods From April 2018 to July 2020, CART was performed during the initial treatment of 31 patients with advanced ovarian and peritoneal cancers with cancerous ascites. Patient characteristics and clinical information before and after CART were collected. We performed quality of life assessment using the Japanese version of the M.D. Anderson Symptom Inventory (MDASI‐J) 24 h before and after CART. Results CART was performed 38 times in 24 patients before or during neoadjuvant chemotherapy and 11 times in 11 patients prior to surgery. Four patients underwent CART before primary surgery and before and/or during chemotherapy. Grade 1–2 fever was observed in 18 of 31 cases (58%), and all were controllable by nonsteroidal anti‐inflammatory drugs. CART did not adversely affect the main treatment, chemotherapy, or surgery. CART significantly improved the MDASI‐J symptom and interference scores within 24 h after the procedure. The symptom and interference scores decreased from 2.4 to 1.8 and from 4.8 to 3.0, respectively. Conclusions CART can be safely performed and is useful for symptom relief and improvement of general condition prior to initial surgery and during initial chemotherapy in ovarian and peritoneal cancers. Performing CART at the time of initial treatment may facilitate initiation of the main treatment.

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“…In recent years, CART has been actively used in combination with chemotherapy for peritoneal dissemination cases with a large amount of ascites [14][15][16][17]. When chemotherapy and CART are used in combination, there are concerns about side effects due to the concentration of the drug in ascites and reinfusion into the blood.…”

Section: (3) Cell-free and Concentrated Ascites Reinfusion Therapy (Cart)mentioning

confidence: 99%

Clinical practice guideline for the treatment of malignant ascites: section summary in Clinical Practice Guideline for peritoneal dissemination (2021)

Matsusaki¹,

Aridome

Emoto

et al. 2021

Int J Clin Oncol

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Patients with peritoneal dissemination (PD) caused by abdominal malignancies are often associated with massive ascites, which shows extremely dismal prognosis because of the discontinuation of systemic chemotherapy mostly due to poor performance status. Many treatment methods, such as simple drainage, peritoneovenous shunting (PVS) and cell-free and concentrated reinfusion therapy (CART), have been used for symptom relief. However, the clinical efficacies of these methods have not been fully investigated yet. Recently, we developed the Clinical Practice Guideline for PD caused by various malignancies according to "Minds Clinical Practice Guideline Development Guide 2017". In this guideline, we systematically reviewed information on clinical diagnosis and treatments for PD using PubMed databases (2000 – 2020), and clarified the degree of recommendation for clinical questions (CQ). The evidence level was divided into groups by study design and quality. The literature level and a body of evidence were evaluated in reference to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Based on the results of systematic review, the strength of the recommendations was evaluated at a consensus meeting of the Guideline Committee. This is the English synopsis of the part of treatment of malignant ascites in Clinical Practice Guideline for PD, 2021 in Japanese. The guidelines summarize the general aspect of the treatment of malignant ascites and statements with recommendation strengths, evidence levels, agreement rates and future perspective for four raised clinical questions.

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Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in gastrointestinal cancer patients with massive ascites treated with systemic chemotherapy

Cited by 11 publications

References 17 publications

Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Quality of life assessment of cell‐free and concentrated ascites reinfusion therapy during initial treatment for advanced ovarian cancer: A prospective cohort study

Clinical practice guideline for the treatment of malignant ascites: section summary in Clinical Practice Guideline for peritoneal dissemination (2021)

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