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Side-Hole Catheter Placement for Hepatic Arterial Infusion Chemotherapy in Patients with Liver Metastases from Colorectal Cancer: Long-Term Treatment and Survival Benefit

¹ All authors: Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Kawagishi-cho, Chuo-ku, Niigata 951-8566, Japan.

View larger version (21K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Four types of catheter placement methods. Schematic diagram shows conventional method: 5-French end-hole catheter is simply inserted in common hepatic artery. Gastroduodenal artery (arrows) and right gastric artery (arrowhead) are then embolized using coils.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Four types of catheter placement methods. 75-year-old woman with liver metastases from sigmoid colon cancer. Arteriogram via catheter-port system shows catheter placement using conventional method. Gastroduodenal artery (arrows) and right gastric artery (arrowhead) are embolized using coils.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Four types of catheter placement methods. Schematic diagram shows original fixed catheter tip method: 5-French side-hole catheter is implanted in hepatic artery, with side hole of catheter placed in common hepatic artery and distal catheter shaft fixed within gastroduodenal artery by coils (straight arrows). Inside lumen of tapered catheter tip is occluded using microcoil (curved arrow). Right gastric artery is embolized using coils (arrowhead).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Four types of catheter placement methods. 49-year-old man with liver metastases from sigmoid colon cancer. Arteriogram via catheter-port system shows catheter placement using original fixed catheter tip method. Distal shaft of catheter is fixed in gastroduodenal artery using coils (thin black arrows), with side hole located in common hepatic artery. Inside lumen of catheter tip is occluded using microcoil (white arrow). Posterior superior pancreaticoduodenal artery (thick black arrow), accessory left gastric artery arising from left hepatic artery (large arrowhead), and right gastric artery (small arrowhead) are embolized by coils.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Four types of catheter placement methods. Schematic diagram shows modified fixed catheter tip method. Long tapered side-hole catheter is implanted, in which 2.7-French, 20-cm-long distal loop of catheter is inserted in hepatic artery, with side hole placed in common hepatic artery, and tip and distal shaft of catheter fixed in gastroduodenal artery by coils (arrows). Even if coils do not reach around catheter tip, lumen of tip of 2.7-French catheter is coagulated and closed spontaneously. Right gastric artery is then embolized by coils (arrowhead).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Four types of catheter placement methods. 72-year-old man with liver metastases from transverse colon cancer. Arteriogram via catheter-port system shows catheter placement using modified fixed catheter tip method. Tip and distal shaft of long tapered catheter are fixed in gastroduodenal artery by coils (arrows), with side hole placed in common hepatic artery. Right gastric artery (large arrowhead) and posterior superior pancreaticoduodenal artery (small arrowhead) are embolized by coils.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —Four types of catheter placement methods. Schematic diagram shows long tapered catheter placement method. Long tapered side-hole catheter is introduced into hepatic artery; 2.7-French, 20-cm-long distal loop of catheter is inserted distally into peripheral hepatic artery, with side hole placed in proper hepatic artery. Right gastric artery is occluded using coils (arrowhead). It is not necessary to embolize gastroduodenal artery when side hole is in stable position in proper hepatic artery.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —Four types of catheter placement methods. 56-year-old-man with liver metastases from rectal cancer. Arteriogram via catheter-port system shows catheter implantation using long tapered catheter placement method. Long tapered catheter loop is inserted distally into hepatic artery, with side hole placed in proper hepatic artery. Right gastric artery is embolized by coils (arrow). In addition, right inferior phrenic artery (arrowheads), which has parasitic blood supply to liver, is occluded using mixture of N-butyl cyanoacrylate and iodized oil.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Graph shows Kaplan-Meier curves for time receiving treatment according to method of catheter placement. Time to treatment discontinuation is significantly longer in patients treated with original or modified fixed catheter tip or long tapered catheter placement methods than in patients treated with conventional method (p < 0.0001, p = 0.0002, and p = 0.0019, respectively, log-rank test).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Graph shows Kaplan-Meier curves for hepatic progression according to method of catheter placement. Time to hepatic progression is significantly longer in patients who received treatment with original or modified fixed catheter tip or long tapered catheter placement methods compared with patients who received treatment with conventional method (p = 0.0049, p = 0.0141, and p = 0.0004, respectively, log-rank test).

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Graph shows Kaplan-Meier curves for extrahepatic progression according to method of catheter placement. No significant difference is noted among four groups (p > 0.75, log-rank test).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Graph shows Kaplan-Meier curves for overall survival according to method of catheter placement. Overall survival is significantly better in patients treated with original or modified fixed catheter tip or with long tapered catheter placement method compared with patients treated with conventional method (p = 0.0146, p = 0.0036, and p = 0.0017, respectively, log-rank test).

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