CT-guided percutaneous intratumoral chemotherapy with a novel cisplatin/epinephrine injectable gel for the treatment of unresectable malignant liver tumors

Purpose: To evaluate prospectively the volumetric changes of tumor and necr osis in unresectable malignant liver tumors and the clinical aspects after CT-guided direct intratumoral administration of a novel cisplatin/epinephri ne injectable gel in a clinical phase II study. Patients and methods: 8 pat ients with 17 colorectal liver metastases with a mean volume of 42 ml were treated with a mean of 5.1 injections and 8 patients with 11 HCC nodules (m ean volume of 22.1 ml) with a mean of 3.25 treatments with CT-guided local administration of a novel cisplatin/epinephrine gel. This method of adminis tration provides a higher local and lower systemic drug concentration. Volu mes of tumor and necrosis prior to and after treatment were measured by com puter-generated volumetric analysis. Results: Contrast-enhanced studies ver ified pretherapeutic tumor necrosis with a value of 12.6% in the metastases and 0.6% in the HCC nodules. Intratumoral drug administration resulted in a necrotic volume of 110% in metastases and 128% in HCC versus the mean ini tial tumor volume, at least 4 treatments resulted in 122% necrosis in metas tases and 130% in HCC. Local therapy control rate for the follow-up to 6 mo nths was 38% and 83.3% for the group of metastases and HCC, respectively. C onclusions: Direct intratumoral injection of a novel cisplatin/epinephrine injectable gel results in an induction of a relevant necrosis in malignant liver tumors, with a substantially higher local therapy control rate for HC C compared to colorectal metastases.