What Is a Chemotherapy Catheter?

Bladder cancer transcatheter arterial chemotherapy for bladder cancer includes surgical resection, chemotherapy, and radiation therapy.

Transcatheter arterial chemotherapy

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Transcatheter arterial chemotherapy for bladder cancer

Transurethral resection of bladder tumor (TUR-BT) is widely used because it saves the bladder only by removing the tumor, but this method is only applicable to those earlier tumors. In clinical practice, bladder cancer is generally treated with comprehensive therapy, that is, surgery (including TUR-BT), chemotherapy and / or radiation therapy are used in combination, while those who have no indication for surgery are mainly chemotherapy. There are two methods of chemotherapy, namely systemic chemotherapy (intravenous route) and local chemotherapy. Local chemotherapy can include transarterial chemotherapy and transurethral intravesical infusion chemotherapy.

Transcatheter arterial chemotherapy

Transcatheter arterial chemotherapy for bladder cancer is suitable for preoperative and / or postoperative chemotherapy of all stages of bladder cancer.

There are no contraindications in principle, but should be relatively contraindicated in cases of heart, kidney failure, coagulopathy, cachexia, etc.

1. Chemotherapy drugs Compared with chemotherapeutic drugs, cisplatin and carboplatin are widely accepted. They can be used alone in large doses, and they are best used in combination with other chemotherapeutic drugs.

2. Embolizers generally do not advocate embolization of bladder cancer. For those cases with significant bleeding and large tumors, an appropriate amount of gelatin sponge particles can be used to embolize the internal iliac artery (the bladder artery need not be superselected). Do not use permanent embolic agents for embolization.

3. Analyze and discuss the patient's various test results before operation to understand the basic conditions such as liver and kidney function, determine the location of the tumor to guide medication, and conduct an iodine allergy test.

1. Anatomy of pelvic vessels such as the bladder The blood supply of pelvic organs such as the bladder is mainly from the internal iliac artery, however, the specific vascular anatomy is often very complicated. The bladder usually receives blood from four arteries, the superior and inferior bladder arteries. Theoretically, for transcatheter chemotherapy of bladder cancer, the catheter should be super-selected to the above 4 bladder arteries and then TAI, so as to achieve a higher local chemotherapeutic drug concentration in the tumor and minimize the damage to adjacent organs. Anatomical characteristics (a large number, small diameter, and large changes in opening position), it is often very difficult to superselect the intubation. A large amount of practical experience proves that good results can be obtained without superselective chemotherapy of the bladder artery, and its side effects are often transient without special treatment. In fact, for bladder cancer with lymph node metastasis in the pelvis, a wider area of arterial chemotherapy is more conducive to improving the treatment effect.

2. Perform bilateral internal iliac arteriography to understand the anatomy of the blood vessels. The catheter should pass the superior gluteal artery as much as possible during injection. For those who cannot be crossed due to anatomical relationship, a steel ring can be used to embolize the main gluteal artery. Arterial arterial injection can also be directly injected through the internal iliac arterial trunk. TAI should be performed on both sides of the internal iliac artery, and the dose on both sides should be adjusted appropriately for tumors at non-midline sites based on clinical examination results.

3. When using large doses of cisplatin for chemotherapy, intravenous infusion of antidote (sodium thiosulfate) should be used to neutralize its renal toxicity.

4. For cases where it is necessary to embolize, mix gelatin sponge particles with contrast agent and inject slowly under fluoroscopy.

5. Complications: kidney toxicity, bladder and rectal mucosal damage, sexual dysfunction, skin and nerve damage. Most complications are transient and require no special treatment.

Some people advocate using a balloon catheter to temporarily occlude the proximal iliac artery by using a balloon, which will significantly slow down the blood flow in the pelvic cavity, thereby extending the contact time between the drug and the tumor. Some people use a steel ring to embolize the main internal iliac artery on one side (the non-tumor superior side), and then leave the catheter in the internal iliac artery on the other side, so that the catheter can be left in the body for several days to facilitate the implementation of various chemotherapy regimens. .

Pay attention to prevention and treatment of complications.