Puncion subclavia

Cardiovasc Intervent Radiol (2009) 32:1059–1066 DOI 10.1007/s00270-009-9510-1

TECHNICAL NOTE

Development of a New Subclavian Arterial Infusion Chemotherapy Method for Locally or Recurrent Advanced Breast Cancer Using an Implanted Catheter–Port System After Redistribution of Arterial Tumor Supply
Kenji Takizawa Æ Hiroshi Shimamoto Æ Yukihisa Ogawa Æ Misako Yoshimatsu Æ Kunihiro Yagihashi ÆYasuo Nakajima Æ Takashi Kitanosono
Received: 4 August 2008 / Accepted: 8 January 2009 / Published online: 24 February 2009 Ó Springer Science+Business Media, LLC 2009

Abstract Locally or recurrent advanced breast cancers can receive arterial blood supply from various arteries, such as the internal thoracic artery (ITA), the lateral thoracic artery, and the other small arterial branchesoriginating from the subclavian artery. Failure to catheterize and subsequent formation of collateral arterial blood supply from various arteries are some of the reasons why the response to conventional selective transarterial infusion chemotherapy is limited and variable. To overcome this problem, we developed a new subclavian arterial infusion chemotherapy method using an implanted catheter–portsystem after redistribution of arterial tumor blood supply by embolizing the ITA. We named this technique (‘‘redistributed subclavian arterial infusion chemotherapy’’

K. Takizawa (&) Á H. Shimamoto Á Y. Ogawa Á M. Yoshimatsu Á K. Yagihashi Á Y. Nakajima Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae, Kawasaki, Kanagawa, Japan e-mail: taki-lrl@vy.catv.ne.jp H.Shimamoto e-mail: hshima@k8.dion.ne.jp Y. Ogawa e-mail: yukky-p406c@nifty.com M. Yoshimatsu e-mail: misako_yosh@yahoo.co.jp K. Yagihashi e-mail: yagiku@hotmail.com Y. Nakajima e-mail: y3naka@marianna-u.ac.jp T. Kitanosono Department of Vascular/Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY, USA e-mail: tkita1@mac.com

(RESAIC)). UsingRESAIC, patients can be treated on an outpatient basis for extended periods of time. Eleven patients underwent RESAIC, and the complete remission and partial response rate in 10 evaluable patients was 90%: complete remission [CR] n = 4, partial remission n = 4, stable disease n = 1, and not evaluable n = 1. Three of four patients with CR had no distant metastasis, and modified radical mastectomy wasperformed 1 month after conclusion of RESAIC. The resected specimens showed no residual cancer cells, and pathologically confirmed complete remission was diagnosed in each of these cases. Although temporary grade-3 myelosuppression was seen in three patients who were previously treated by systemic chemotherapy, there was no other drug-induced toxicity or procedure-related complications. RESAICproduced a better response and showed no major complications compared with other studies despite the advanced stage of the cancers. Keywords Interventional Radiology Á Breast cancer Á Arterial infusion chemotherapy Á Implanted port

Introduction Locally or recurrent advanced breast cancers (ABC) are defined as large tumors with extensive regional lymph node involvement or direct invasion of the skinor underlying chest wall [1]. These cancers are considered stages IIIa and IIIb according to the tumor-node-metastasis classification system adopted by the Japanese Breast Cancer Society, which is based on the classification system of the International Union Against Cancer [2]. Inflammatory breast cancer showing extensive histologic infiltration of dermal lymphatics is a distinct subset.

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K. Takizawa et al.: New Subclavian Arterial Chemotherapy Method

Some previous reports showed that arterial infusion chemotherapy (AIC) was effective for ABC [3–5]. The local response rate was reported to be 70–90%, and rapid tumor regression was seen after the treatment [6–10]. However, problems associated with AIC should be resolved as will be described later. Conventionally in AIC...