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A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric
Francesca Martella1, Vanda Salutari, Claudia Marchetti
1aOncology Department, Azienda Sanitaria Firenze, Istituto Toscano Tumori, Florence bGynecologic Oncology Unit, Policlinico Gemelli, Cattolica University cDepartment of Gynecological and Obstetrical Sciences and Urological Sciences, Policlinico Umberto I, La Sapienza University, Rome dDivision of Oncology, Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples eOncology Department, Azienda Ospedaliero Universitaria, Modena fDepartment of Obstetrics and Gynecology II, Azienda Ospedaliera Policlinico Universitario, Bari, Italy.
Insights
Peripherally inserted central venous catheters (PICCs) offer a cost-effective and safe alternative to PORT-chamber catheters (PORTs) for short-term trabectedin administration. PICCs demonstrate a better cost-efficiency ratio for use under one year.
Area of Science:
- Oncology
- Vascular Access Devices
- Pharmacoeconomics
Background:
- Trabectedin administration via central venous catheter (CVC) is recommended to prevent extravasation.
- Central venous catheters (CVCs) pose risks of complications and incur significant costs for oncology departments.
- PORT-chamber catheters (PORTs) and peripherally inserted central venous catheters (PICCs) are common CVCs.
Purpose of the Study:
- To evaluate the relative cost-effectiveness of PORTs versus PICCs for trabectedin administration.
- To assess the safety and tolerability of PICCs for trabectedin infusion.
Main Methods:
- Retrospective review of data from 102 trabectedin-treated patients across six Italian centers.
- Comparison of complication rates and cost-efficiency between patients receiving trabectedin via PICC or PORT.
- PICC insertion performed by trained nurses; PORT insertion required a surgical day procedure.
Main Results:
- No significant difference in device dislocation or infection rates between PORT and PICC groups.
- One case of thrombosis reported in the PORT group; no PICC misplacements or early malfunctions occurred.
- PORT demonstrated better cost-efficiency only for devices used longer than one year.
Conclusions:
- Trabectedin infusion via PICC is safe, well-tolerated, and offers preferable cost-efficiency for short-term use (≤1 year).
- PICCs represent a viable and potentially more economical alternative to PORTs for specific patient populations and treatment durations.
Abstract:
The European Medicines Agency strongly recommends administration of trabectedin through a central venous catheter (CVC) to minimize the risk of extravasation. However, CVCs place patients at risk of catheter-related complications and have a significant budgetary impact for oncology departments. The most frequently used CVCs are subcutaneously implanted PORT-chamber catheters (PORTs); peripherally inserted central venous catheters (PICCs) are relatively new. We reviewed data of trabectedin-treated patients to evaluate the relative cost-effectiveness of the use of PORTs and PICCs in six Italian centres. Data on 102 trabectedin-treated patients (20 with sarcoma, 80 with ovarian cancer and two with cervical cancer) were evaluated. Forty-five patients received trabectedin by a PICC, inserted by trained nurses using an ultrasound-guided technique at the bedside, whereas 57 patients received trabectedin infusion by a PORT, requiring a day surgery procedure in the hospital by a surgeon. Device dislocation and infections were reported in four patients, equally distributed between PORT or PICC users. Thrombosis occurred in a single patient with a PORT. Complications requiring devices removal were not reported during any of the 509 cycles of therapy (median 5; range 1-20). PICC misplacement or early malfunctions were not reported during trabectedin infusion. The cost-efficiency ratio favours PORT over PICC only when the device is used for more than 1 year. Our data suggest that trabectedin infusion by PICC is safe and well accepted, with a preferable cost-efficiency ratio compared with PORT in patients requiring short-term use of the device (≤1 year).
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