Efficacy of selective transarterial chemotherapy using a port systemfor angiosarcomas of the face and scalp

Abstract

Angiosarcoma is a rare, highly malignant tumor with a poor clinical outcome. From January 2004 to September 2005, we advocated transarterial chemotherapy using a port system for four patients with angiosarcomas of the face and scalp. A heparin coated ANTHRON P-Ucatheter was introduced into the feeding artery. The proximal part of the P-U catheter was connected to the port system and buried in subcutaneous tissue. The amount of chemotherapeutic drug applied using the port system was almost the same as the conventional intravenous dose. Paclitaxel was the standard agent, at 50-100 mg/diluted in 15-30 ml of physiological saline fluid slowly injected over 0.5-1 hour. For immunotherapy where appropriate, r-IL2 was mainly used at a dose of 70.000U/ diluted in 5 ml of physiological saline fluid injected into the port system over 30 seconds. This was continued for two to three weeks (five days/week) until recognition of a disappearance of the tumor. Macroscopic size reduction of the tumor was achieved in three out of the four cases. One case could not be evaluated because of eruptions induced by immunotherapy. Unfortunately two patients died after placement of port system, but the other two are still alive and are enjoying useful lives. Transarterial infusion chemotherapy using such a port system may be particularly effective for angiosarcoma in the early stages because small lesions with limited invasion mean a small territory of blood supply to be covered, and useful life was possible because the port system embedded in subcutaneous tissue allows treatment in an out-patient clinic.

Figure 1

T1-weighted MR image with gadolinium enhancement showing a lesion with irregular enhancement located in the right posterior fossa destroying the bone structure.

Figure 2

Right external carotid angiogram showing a lucent stain distributed by the occipital artery.

A

B

Figure 4

Plain cervical X ray showing an ANTHRON P-U catheter.

Figure 5

T1-weighted MR image with gadolinium enhancement three months after transarterial chemotherapy using the port system showing a disappearance of the lesion.