Epirubicin is the 4' epimer of the anthracycline antibiotic doxorubicin, and has been used alone or in combination with other cytotoxic agents in the treatment of a variety of malignancies. Comparative and noncomparative clinical trials have demonstrated that regimens containing conventional doses of epirubicin achieved equivalent objective response rates and overall median survival as similar doxorubicin-containing regimens in the treatment of advanced and early breast cancer, non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), non-Hodgkin's lymphoma, ovarian cancer, gastric cancer and nonresectable primary hepatocellular carcinoma. Recently, dose-intensive regimens of epirubicin have achieved high response rates in a number of malignancies including early and advanced breast cancer and lung cancer. The major acute dose-limiting toxicity of anthracyclines is myelosuppression. In vitro and clinical studies have shown that, at equimolar doses, epirubicin is less myelotoxic than doxorubicin. The lower haematological toxicity of epirubicin, as well as the recent introduction of supportive measures such as colony-stimulating factors, has allowed dose-intensification of epirubicin-containing regimens, which is particularly significant because of the definite dose-response relationship of anthracyclines. Cardiotoxicity, which is manifested clinically as irreversible congestive heart failure and/or cardiomyopathy, is the most important chronic cumulative dose-limiting toxicity of anthracyclines. Epirubicin has a lower propensity to produce cardiotoxic effects than doxorubicin, and its recommended maximum cumulative dose is almost double that of doxorubicin, thus allowing for more treatment cycles and/or higher doses of epirubicin. In summary, dose-intensive epirubicin-containing regimens, which are feasible due to its lower myelosuppression and cardiotoxicity, have produced high response rates in early breast cancer, a potentially curable malignancy, as well as advanced breast, and lung cancers. Furthermore, there is evidence to suggest that improved response rates can improve quality of life in some clinical settings, but whether this leads to prolonged survival has not yet been determined. Recently implemented supportive measures such as colony-stimulating factors, prophylactic antimicrobials and peripheral blood stem cell support may help achieve other potential advantages of dose-intensive epirubicin-containing regimens such as reductions in morbidity and length of hospital admissions.

Epirubicin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in cancer chemotherapy.

Preoperative embolization in spinal and pelvic metastases.

OBJECTIVE. The purpose of this study was to evaluate, in relation to intraoperative estimated blood loss (EBL), the effectiveness of preoperative transcatheter arterial embolization of hypervascular osseous metastatic lesions before orthopedic resection and stabilization.MATERIALS AND METHODS. Between June 1987 and November 2007, 22 patients underwent transcatheter arterial embolization of tumors of the long bone, hip, or vertebrae before resection and stabilization. Osseous metastatic lesions from renal cell carcinoma, malignant melanoma, leiomyosarcoma, and prostate cancer were embolized. All patients were treated with a coaxial catheter technique with polyvinyl alcohol (PVA) particles alone or a combination of PVA particles and coils. After embolization, each tumor was angiographically graded according to devascularization (grades 1–3) based on tumor blush after contrast injection into the main tumor-feeding arteries.RESULTS. In patients with complete devascularization (grade 1), mean EBL was calculate...

Interventional Management of Hypervascular Osseous Metastasis: Role of Embolotherapy Before Orthopedic Tumor Resection and Bone Stabilization

Transarterial embolization of primary and secondary tumors of the skeletal system.

Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion. Successful embolization (> 70% obliteration of vascularit...

/pdf/preoperative-embolization-in-surgical-treatment-of-long-bone-1kdms3ad1l.pdf

Preoperative embolization in surgical treatment of long bone metastasis: a systematic literature review

Eighteen patients (11 renal tumours, 3 bronchogenic carcinomas, 4 others) with 24 different bone metastases were embolized for preoperative devascularization (11 x) or for intractable pain (7 x). Metastases were localized in the spine (17 x), pelvis (5 x), and shoulder girdle (2 x). All metastases were hypervascularized. Post-embolization showed no complications. Intraoperative blood loss was minimized to 2100 ml (600 ml-4200 ml). Pain relief was achieved in 6 out of 7 patients. Eight of 18 patients died as a result of underlying diseases (follow-up 7 months).

Embolization of bone metastases

Forty-two patients with locally advanced breast cancer (n = 8) or recurrent breast cancer (n = 34) received regional chemotherapy (mitoxantrone 25 mg/m2 per 24 h) via the internal mammary artery or other vessels of the subclavian artery. To prevent artery thrombosis 500-1000 U heparin per hour were administered i.v. Tumour perfusion was monitored by intra-arterial angio-CT. Remission rates (CR + PR) were 100% (primary breast cancer) and 89% (recurrent tumours), respectively. Intra-arterial chemotherapy was well tolerated. No complications were noted.

[Superselective intra-arterial chemotherapy in breast cancer].

[Side effects and complications of intra-arterial tumor therapy--experiences with 577 interventions].

Spinal cord ischemia complicating hepatic artery chemoembolization in a patient with prior hemihepatectomy

PURPOSE To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.

[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma].

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