HAIC

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HAIC Toray Anthron P-U Catheter

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Contents

• HAIC
• ?Advantages of HAIC
• ?Paper Discussion
• Toray Anthron P-U Catheter
• ?What is APUC?
• ?Animal test
• ?Types of Anthron? P-U Catheter
• ?Instructions for implantation
• ?APUC???????
• ?Regimen
• ?Peroration

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HAICltHepatic Arterial infusion chemotherphygt
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Advantages of HAIC

• Increase the local drug concentration
• Good response rate
• Prolong the survival
• Reduction in systemic side effects
• Made it possible to perform treatment on an
  outpatient basis

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Paper Discussion

• HCC with PVTT
• Liver Metastases from Colon Cancer
• Liver Metastases from Gastric Cancer
• Liver Metastases from Breast Cancer

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HCC with PVTT

• Dr. Tanaka

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HCC with PVTT

• ????

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Liver Metastases from Colon Cancer

• Dr. Kemeny ( Memorial Sloan-Kettering Cancer
  Center )
• ?receive 6 cycles of HAI with floxuridine and
  dexamethasone plus intravenous fluorouracil, with
  or without leucovorin(Group A), or 6 wks of
  similar sys alone (Group B). (p0.03)
• ?At 2 yrs,the risk ratio of B/A2.34.

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Liver Metastases from Colon Cancer
Arai, M.D.
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Liver Metastases from Colon Cancer
Tetsuo Taguchi, M.D.
Osaka University Medical School
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Liver Metastases from Gastric Cancer
Tetsuo Taguchi, M.D.
Osaka University Medical School
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Liver Metastases from Breast cancer
Tetsuo Taguchi, M.D.
Osaka University Medical School
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Toray Anthron P-U Catheter
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What is Anthron? ?
Anthron? is hydrophilic polymer which is
ionically bound Heparin and originally
developed by Toray. Anthron? continues to
release Heparin into blood for a long term period
which prevents thrombus formation.
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Raw material of this catheter

• ?Tube Polyurethane
• ?Coating on outer surface Anthron
• ?Coating on inner surface Anthron
• about 8 cm from distal end.
• (Catheters with entire inner surface coated is
  under development.)
• ?The surface of catheter becomes slippery after
  moistening, then, manipulation(??) in blood
  vessel is smooth.

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Heparin Release Curve fromAnthron P-U Catheter
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Concept Target

• ?Catheter for long-term inderwelling?
• ? Catheter for chemotherapy ?

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Animal test

• Material Method
• ?Material
• silicon catheter
• Anthron P-U Catheter
• ?Animal
• Dogs(Biegle)
• ?Indwelling place
• from femoral vein to
• vena cava
• ?Indwelling term
• 6 months

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Test results(1)
Analysis of blood components after indwelling
WBC
RBC
Seg-Neutrophile
a2-globlin
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Test results(2)
Frequency of pulmonary embolism(n87)
Observation by optical microscopy
Anthron?
Silicone
Silicone higher risk of PE
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Test results(3)
Frequency of phlebitis on indwelling place(n87)
Observation by eyes
Anthron?
Silicone
Observation by optical microscopy
Anthron?
Silicone
Frequency of phlebitis where the catheter is
placed
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Test results(4)
Frequency of thrombus formation on catheter
surface
Observation by SEM
Anthron?
Silicone
Anthron?lower risk of thrombus formation due to
catheters indwelling
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Types of Anthron P-U Catheter
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Instructions for implantation
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Instructions for implantation

• ?Check the tumor location using an angiographic
• catheter.
• If necessary, redistribute the blood
  circulation
• ?Insert a guidewire into the angiographic
  catheter
• ?The guidewire must not be removed into the
• vessel. Then remove the angiographic
  catheter.

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?Insert an indwelling catheter into the
vessel by the Seldinger technique.

• ?Slide in the catheter through the
• guidewire until it reaches the target
• vessel.

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• ?Indwell the catheter at the site to be treated,
  assuring the position of the end of the catheter
  with the radioscope. To reduce the risk of the
  dislocation of the catheter, coil down the
  catheter into the aorta.

?Cut the catheter to adjust the length
appropriately
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?Prepare the ST301C or ST305C manufactured
by B. Braun Aesculap.
?Insert a lock for ST301C or ST305C over the
catheter ring, over the proximal end of the
catheter.
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?Insert the exit cannula of ST301C or ST305C
into the catheter, as in the following
illustration.
?Fix the lock ring onto the portal.
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IA Catheter ????????

• Conventional percutaneous method
• CHA-coil ?
• SPA-coil ?
• GDA-coil?

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Converntional percutaneous method

• RGA and GDA were embolized and the indwelling
  catheter was inserted to PHA

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CHA-coil ?

• RGA was embolized and the indwelling catheter
  was inserted into PHA, then CHA was embolized by
  coils.

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SPA-coil ?

• Embolization of RGA, GDA, LGA and DPA were
  performed before the following catheter
  placement. The indwelling catheter was inserted
  to SPA with the catheter-tip fixed employing
  steel coils and NBCA-Lipiodol mixture, the side
  hole of which was placed on the celiac artery.

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GDA-coil ?

• Embolization of RGA was performed before the
  following catheter placement. The indwelling
  catheter was inserted to GDA with the
  catheter-tip fixed employing steel coils and
  NBCA-Lipiodol mixture, the side hole of which was
  placed on CHA.

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Regimen
For HCC (1) High dose5-FUIfa(for one month)
IF
IF
IF
5-FU (1600mg/body)
5-FU (1600mg/body)
Response Rate50
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For HCC (2) Low dose5-FUCDDP(for one month)
5-FU (250mg/body)CDDP (10mg/body)
Response Rate60
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For HCC (3) EEP (for one month)
Etoposido 8090mg/body
CDDP 70mg/body
CDDP 70mg/body
EP 50mg/body
EP 50mg/body
Response Rate43
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For Metastasis WHF
5-FU 1600mg/body for 5-FU
5-FU 1600mg/body for 5-FU
One-time/week
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Peroration
HAIC Toray Anthron P-U Catheter is the best.