CT-guided intratumoural administration of cisplatin/epinephrine gel for treatment of malignant liver tumours

Abstract

To analyze prospectively the interventional and clinical aspects of computed tomography-guided direct intratumoural injection of a novel chemotherapeutic administration and the parenchymal changes of tumour and necrosis in malignant liver tumours. Eight patients with 17 colorectal liver metastases were treated with a mean of 5.1 injections and nine patients with 13 hepatocellular carcinoma nodules with a mean of 3.1 treatments with computed tomography guided local applications of a novel cisplatin/epinephrine gel. This application provides a higher local and lower systemic drug concentration. Volumes of tumour and necrosis prior and after treatment were measured by computer generated volumetric analysis. Contrast enhanced studies verified pretherapeutic viable tumour volumes with a value of 77.4 ml in the metastases and 29.2 ml in the hepatocellular carcinoma nodules. Intratumoural drug application resulted in a significant increase of necrosis and a decrease in viable tumour volume to be 68.3 ml in metastases and 14.5 ml in hepatocellular carcinoma. Local therapy control rate for the follow up to 6 months was 38 and 71% for the group of metastases and hepatocellular carcinoma, respectively. Direct intratumoural injection of cisplatin/epinephrine injectable gel is a feasible and good tolerated method and results in the development of a statistically significant increase in necrosis in malignant liver tumours. For hepatocellular carcinoma a higher local therapy control rate compared to colorectal metastases can be reported.

Figure 1

Visualization of the injection procedure in a hepatic metastasis (open arrows) shown in segment 5 using the CARE vision CT programme. Note the needle placed centrally in the tumour (arrow).

Figure 2

Volumetric measurements of viable tumour volumes before treatment (screen) and 2 weeks and 2 months after last treatment.

Figure 3

(a) 69-year-old patient with histopathologically proven HCC in segment 5/8. Pretreatment CT scan on the left side, lesion identified with decreased attenuation values. CT scan 2 weeks after the fourth/last treatment with IntraDose® gel. Segment 5/8 reveals an irregular area of necrosis that developed after treatment (arrows). Both scans portal venous phase. (b) MRI scan (T2-weighted) 2 years after treatment, The lesion is still detectable but has not changed in size, the patient is in a good clinical condition.

Figure 4

A 55-year-old patient with colorectal metastases to the liver. (a) Pretreatment CT scan in segment 8 (portal venous phase). (b) CT scan (portal venous phase) at 8 weeks after the pretreatment evaluation and 2 weeks after the fourth treatment. Increased tumour necrosis is evident after treatment.