ULTRASOUND GUIDED INTRA-ARTERIAL AXILLARY CHEMOTHERAPY FOR PALLIATIVE CARE OF LOCALLY ADVANCED BREAST CANCER PATIENTS
Skrynnyk K.V.1, Suprunenko O.A.1, Bubnov R.V.2, Abdullaiev R.Y.3
1 National Institute of Cancer
2 Clinical Hospital ”Pheophania“ of State Affairs Department, Kyiv, Ukraine
3Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Breast cancer is now the most common cancer type in both developed and developing countries, accounting for a quarter of all cancers in women. Patients with inoperable advanced breast cancer (LABC) evoke many symptoms as pain, oedema, and require palliative therapy for improvement of life quality. Chemotherapy may be effective palliative care for such patients, locally delivered intra-arterial chemotherapy may improve the disease course and life quality. Many methodologic limitations still exist that for providing selective chemotherapy, and ultrasonography (US) is known as effective tool for guidance interventional procedures in soft tissues.
The aim was to assess feasibility of ultrasound guided intraarterial axillary chemotherapy for palliative care of infiltrative oedematous breast cancer patients.
Materials and methods.
We included consecutive 62 patients, females (35–62 years, 52±7 years old), who were diagnosed an inflammatory-edematous T3-4N1Mx breast cancer, and suffered from pain as local oedema and thoracic and shoulder pain. All patients underwent extensive clinical examination according to the protocol for breast cancer, and responded to 36-Item Short Form Health Survey (SF-36) questionnaire on baseline and on 30th day after procedure. All patients underwent the puncture of ipsilateral axillar artery under US guidance with catheter installation in operating room. Free hand ‘out of plane’ technique using linear 8-10 MHz probes was utilized. Selective chemotherapy scheme was delivered during 3-5 sessions. Radiography confirming of catheter position was conducted in each case.
Disclosure: these results were presented at the ISMUS congress in Szeged, Hungary in 2014 [http://www.ismus-congress.info/information/scientific_program.asp].
All puncture procedures under US guidance were successful, in 20 patients a catheter was placed into lateral thoracic artery, that was confirmed on arteriography. In 26 (81 %) patients symptoms relief was diagnosed, chemotherapy significantly improved upper limb lymphedema and pain - VAS scores to 4.7 from 8.3 (p <0.01), and improved of the quality of life - the mean SF-36 score was 7.8 before, compared to 20.1 after the treatment (p <0.01). The main tumor and metastatic lymph node swelling was reduced in all patients. In all patients whom catheter was introduced into lateral thoracic artery symptoms relief was registered (non significant correlation). No complication were registered.
Ultrasound is an effective method for guidance for injection and catheter placement for intra-arterial axillary chemotherapy, without US procedure should not be considered as feasible and reproducible. Placing catheter into lateral thoracic artery probably might be considered as preferable. Further studies are required for evaluation and implementation of such procedure for routine clinical practiсe.