Use of intra-arterial nitrogen mustard therapy in the treatment of cervical and vaginal cancer

Cromer, J. Keith; Bateman, Jeanne C.; Berry, G. Neill; Kennelly, John; Klopp, Calvin T.; Platt, Lois I.

doi:10.1016/0002-9378(52)90068-9

Cited by 42 publications

(5 citation statements)

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“…ia-nac is employed to obtain higher tissue drug concentrations by direct infusion of anticancer agents into the feeding artery of a tumor to maximize the anticancer activity and minimize adverse effects related to drugs entering the systemic circulation. The first report on IA-NAC was published in 1950 by Bierman et al (17), and its use in the gynecological field was reported by cromer et al in 1952 (18). One of the reasons for the lack of popularity of ia-nac is presumed to be the need for special procedures, such as arterial catheterization.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant intraarterial chemotherapy for stage IIB–IIIB cervical cancer in Japanese women

Kudoh¹,

Takahashi²,

Murakami³

et al. 2010

Experimental and Therapeutic Medicine

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Chemoradiotherapy is currently the main treatment for locally advanced cervical cancer, but neoadjuvant intraarterial chemotherapy (IA-NAC) has been reported to achieve favorable results. This study investigated the efficacy of several different IA-NAC regimens. The subjects were 55 patients with stage IIB-IIIB cervical cancer who received IA-NAC between January 1991 and April 2006. IA-NAC was administered for a total of 1-3 courses at 3-week intervals, with three different regimens being employed in chronological order. The response rate achieved with IA-NAC was 90.2% for squamous cell carcinoma, 60% for adenosquamous carcinoma and 42.9% for adenocarcinoma. Surgery was performed after IA-NAC in 36 patients, and radiotherapy alone was performed in 19 patients. The 5-year survival rate was 72.9% for patients with squamous cell carcinoma and 50% for those with adenocarcinoma or adenosquamous carcinoma. PAMF therapy (cisplatin, epirubicin, mitomycin-C and 5-fluorouracil) achieved a response rate of ≥90% for squamous cell carcinoma, as did CDDP + THP therapy (cisplatin plus pirarubicin), while PACF therapy (cisplatin, epirubicin, cyclophosphamide and 5-flurouracil) achieved a better response rate for adenosquamous carcinoma and adenocarcinoma. Grade 3 or 4 hematological toxicity was significantly more common with PAMF therapy. In conclusion, IA-NAC improved the survival of patients with squamous cell carcinoma. CDDP + THP therapy achieved a high response rate with little hematologic toxicity. PACF therapy achieved a significantly higher response rate in patients with adenosquamous carcinoma or adenocarcinoma. Therefore, IA-NAC may be a therapeutic option for locally advanced cervical cancer, particularly using the above-mentioned regimens.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant intraarterial chemotherapy for stage IIB–IIIB cervical cancer in Japanese women

Kudoh¹,

Takahashi²,

Murakami³

et al. 2010

Experimental and Therapeutic Medicine

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“…The early work of Klopp et al, 38 Bierman et al,39 and Cromer et al 40 popularized the use of the catheter method of angiography and IA infusion chemotherapy. The catheter method provided the following advantages over the method of injecting substances by means of a single needle: 1) the substance could be injected into a vessel at any level desired; 2) the risk of extravasation of the injected substance was minimized; 3) the patient could be placed in any position required; and 4) the catheter could be left in situ for longer intervals than when a needle was used.…”

Section: Drug Delivery Systemsmentioning

confidence: 98%

“…Retrograde placement of catheters for the purpose of introducing chemotherapeutic agents was first reported for the treatment of pelvic cancer. Cromer et al 40 introduced catheters into the deep epigastric or profunda femoral artery and advanced them in a retrograde direction through the external iliac artery into the abdominal aorta. Nitrogen mustard was injected every 8 hours in 2mg quantities.…”

Section: Drug Delivery Systemsmentioning

confidence: 99%

Intraarterial chemotherapy for head and neck cancer, part 1: Theoretical considerations and drug delivery systems

Baker

Wheeler

1983

Head Neck

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The principal objective of regional chemotherapy is tumor cell kill. The rationale for regional delivery is based on the steep dose/response curve exhibited by most antineoplastic agents. Intraarterial (IA) chemotherapy has the potential advantage of increased drug concentration at the tumor site, decreased systemic drug levels, and continuous tumor cell exposure to an antineoplastic agent. Despite these advantages, the use of IA chemotherapy has not been universally accepted. This is in part due to the difficulties associated with establishing and maintaining arterial access. Considerable improvement in the techniques and efficacy of regional therapy for head and neck cancer will be necessary before there is widespread clinical acceptance. These improvements must be based on anatomic and pharmacologic factors that ensure success of regional therapy. In addition, the development of safe, reliable delivery systems will be necessary. Part 1 of this two-part article will review these factors and discuss delivery systems.

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“…Preoperative arterial chemotherapy for locally advanced cervical cancer can be traced back as far as the 1960s. The first report on IA-NAC was published in 1950 by Bierman et al [ 18 ], and its use in the gynecological field was reported in 1952 [ 19 ]. IA-NAC is employed to obtain higher tissue drug concentrations by direct infusion of anticancer agents into the feeding artery of a tumor to maximize the anticancer activity and minimize adverse effects related to drugs entering the systemic circulation [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

The comparative study for survival outcome of locally advanced cervical cancer treated by neoadjuvant arterial interventional chemotherapy or intravenous chemotherapy followed by surgery or concurrent chemoradiation

Sun

Hai

et al. 2022

World J Surg Onc

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Objective This study aimed to compare the survival outcome of 3 different treatment groups (arterial interventional chemotherapy or intravenous chemotherapy or concurrent chemoradiotherapy) for locally advanced cervical cancer. Methods A total of 187 patients with pathological stage IB3–IIB cervical cancer (cervical squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2013 to May 2019 were included. Therefore, this article is a retrospective study. We collected data from all eligible patients. And all according to the treatment methods at that time, they were divided into three subgroups: (1) 40 patients who received neoadjuvant arterial interventional chemotherapy + surgery + postoperative chemotherapy (IA-NAC + RS), (2) 63 patients who received neoadjuvant intravenous chemotherapy + surgery + postoperative chemotherapy (IV-NAC + RS), (3) 84 patients who only received concurrent chemoradiotherapy (CCRT). Notably, 108 of these patients met the 5-year follow-up period, and 187 patients met the 3-year follow-up period only. Consequently, we compared 5-year survival and 3-year survival separately. The prognosis (5-year survival and 3-year survival) of the three groups and the chemotherapy efficacy, intraoperative blood loss, operation time, and postoperative pathological risk factors of different subgroups were compared. Results (1) There were no significant differences in the 3-year overall survival (OS) rate, 3-year progression-free survival (PFS) rate, 5-year OS rate, and 5-year PFS rate among the three subgroups (p > 0.05). (2) The chemotherapy response rates of IA-NAC+RS group (37.5%) and IV-NAC+RS group (25.4%) were comparable (p > 0.05). (3) The intraoperative blood loss in the IA-NAC+RS group (average 92.13±84.09 mL) was significantly lower than that in the IV-NAC+RS group (average 127.2±82.36 mL) (p < 0.05). (4) The operation time of the IA-NAC+RS group (average 231.43±63.10 min) and the IV-NAC+RS group (average 219.82±49.11 min) were comparable (p > 0.05). (5) There were no significant differences between the IA-NAC+RS group and IV-NAC+RS group in pathological lymph node metastasis, parametrial invasion, and involvement of lymphovascular space (p > 0.05). Conclusions Neoadjuvant chemotherapy combined with surgery had the same long-term survival benefit as concurrent chemoradiotherapy.

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Use of intra-arterial nitrogen mustard therapy in the treatment of cervical and vaginal cancer

Cited by 42 publications

References 5 publications

Neoadjuvant intraarterial chemotherapy for stage IIB–IIIB cervical cancer in Japanese women

Neoadjuvant intraarterial chemotherapy for stage IIB–IIIB cervical cancer in Japanese women

Intraarterial chemotherapy for head and neck cancer, part 1: Theoretical considerations and drug delivery systems

The comparative study for survival outcome of locally advanced cervical cancer treated by neoadjuvant arterial interventional chemotherapy or intravenous chemotherapy followed by surgery or concurrent chemoradiation

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