Intraarterial chemotherapy

In an effort to overcome the lack of solubility, poor penetration across the blood-brain barrier and decreased delivery of conventional systemic agents by a compromised intratumoral blood supply, several studies have evaluated various combinations of BCNU alone or with other agents delivered intraarterally. Unfortunately, response rates and median survival times observed in patients treated with intraarterial chemotherapy have not been significantly different than those seen in patients treated with standard intravenous nitrosurea-containing regimens, while increased rates of toxicity such as leukoen-cephalopathy, retinal injury, edema, myelosuppression, sepsis, and thrombotic complications have been noted (40-46). 

Doolittle, N.D., Miner, M.E., Hall, W.A., Siegal, T., Jerome, E., Osztie, E., McAllister, L.D., Bubalo, J.S., Kraemer, D.F., Fortin, D., Nixon, R., Muldoon, L.L., and Neuwelt, E.A. (2000) Safety and efficacy of a multicenter study using intraarterial chemotherapy in conjunction with osmotic opening of the blood-brain barrier for the treatment of patients with malignant brain tumors. Cancer 88, 637-647. 

Calo, S., Bonaccorsi, A., Mattavelli, F., Costa, L., Mariani, L., and Cantu, G. (2003), A novel intraarterial chemotherapy using paclitaxel in albumin nanoparticles to treat advanced squamous cell carcinoma of the tongue Preliminary findings, Am. J. Roentgenol., 181(1), 253-260. 

Botet, XF., Watson, R.C., Kemeny, N., Daly, XM., Yeh, S. Cholangitis complicating intraarterial chemotherapy in liver metastases. Radiology 1985 156 335-337... 

Wheeler RH, Ziessman HA, Medvec BR, Juni JE, Thrall JH, Keyes JW, Pitt SR, Baker SR (1986) Tumor blood flow and systemic shunting in patients receiving intraarterial chemotherapy for head and neck cancer. Cancer Res 46 4200 204... 

In past decades, a variety of treatment modalities have been proposed in the battle against breast cancer. Among these therapies, minimally invasive imaging-guided tumor ablation and intraarterial chemotherapy are approaches that deserve further consideration. 

Chemoembolization Chemoembolization with the combination of Ivalon and FUDR (800 mg), mitomycin C (10 mg), or cisplatin (150 mg) for colorectal hepatic metastases led to no significant improvement in response or survival. Yamashita et al. (1993), who treated 68 patients with various hepatic metastases using iodized oil and chemotherapeutic agents,noted a response rate of 22% and a median survival of 10 months. A similar result was observed by Inoue et al. (1989), i.e., a partial response rate of 16% and a median survival period of 11 months. We currently do not perform chemoembolization in patients with metastatic colorectal carcinoma because the survival rates have not improved compared to the less aggressive approach of intraarterial chemotherapy. However, Lang and Brown (1993) and Pentecost et al. (1992) are encouraged by their results for chemoembolization of hepatic metastases from colorectal cancer and they believe that the technique can be recommended as palliative treatment. More recently, Pajkos et al. (1998) treated 41 patients with metastatic colorectal carcinoma to the liver with chemoembolization consisting of Adriamycin (50 mg), mitomycin C (8 mg), cisplatin (50 mg), or carboplatin (150 mg), Lipiodol (10 ml), and starch microspheres every 6 weeks, as well as systemic 5FU (425 mg/m ) and leucovorin 20 mg/m for 5 days every 28 days. The response rate was 68% with a median survival time of 15 months. 

LA. Infusion. In 1961, Byron et al. reported on their experience with intraarterial infusion of ten patients with bladder cancer who failed to respond. The use of intraarterial chemotherapy was reported by Nevin and Hoffman (1975), who surgically implanted catheters into each internal iliac artery. 5-Fluoroura-cil was infused for 10 days and then every other week for 3 months when it was given as an adjunct to chemotherapy. Regression of local disease was seen in six of ten patients. A mean survival time of 25 months was noted in the complete responders. Fourteen of 28 patients responded but, because of the dosage and myelosuppression, local irritation was significant. 

In 2001, about 2,900 new cases of cancer of the bones and joints were diagnosed, and about 1,400 deaths from these cancers were expected. Primary cancers of bones account for less than 0.2% of all cancers. Regional management options consisting of intraarterial chemotherapy and arterial embolization have been used with favorable results in the treatment of osteosarcoma, unre-sectable giant cell tumors, and aneurysmal bone cysts. 

Mokarim A et al. (1997) Combined intraarterial chemotherapy and radiotherapy in the treatment of bladder carcinoma. Cancer 80 1776-1785... 

Link KH, Aigner KR, Kuehn W, et al (1986) Prospective correlative chemosensitivity testing in high-dose intraarterial chemotherapy for liver metastases. Cancer Res 46 4837-4848... 

Stewart DJ, Grahovac Z, Hugenholtz H, Russell N, Richard M, Benoit B. Combined intraarterial and systemic chemotherapy for intracerebral tumors. Neurosurgery 1987 2 207-214. 

West CR, Avellanosa AM, Barua NR, Patel A, Hong CL Intraarterial l,3-bis(2-chloroethyl)-l-nitrosourea (BCNU) and systemic chemotherapy for malignant gliomas a follow-up study. Neurosurgery 1983 13(4)420426. 

Lehane DE, Bryan RN, Horowitz B, et al. Intraarterial cis-platinum chemotherapy for patients with primary and metastatic brain tumors. Cancer Drug Deliv 1983 l(l) 69-77. 

Kahn CE Jr, Messersmith RN, Samuels BL. Brachial plexopathy as a complication of intraarterial cisplatin chemotherapy. Cardiovasc Intervent Radiol 1989 12(l) 47-9. 

Morikawa N, Mori T, Abe T, Kawashima H, Takeyama M, Hori S (1999) Pharmacokinetics of etoposide and carboplatin in cerebrospinal fluid and plasma during hyperosmotic disruption of the blood brain barrier and intraarterial combination chemotherapy. Biol Pharm Bull 22 428-431. 

Fortin D, Desjardins A, Benko A, Niyonsega T, Boudrias M. Enhanced chemotherapy delivery by intraarterial infusion and blood-brain barrier disruption in malignant brain tumors the Sherbrooke experience. Cancer 2005 103 2606-2615. 

Ariel IM, Padula G (1982) Treatment of asymptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes. J Surg Oncol 20 151-156... 

A Step Towards Supraconservative Surgery 103 Interventional Procedures for the Locoregional Treatment of Breast Cancer 105 Percutaneous Imaging-Guided Tumor Ablation 105 Intraarterial Infusion Chemotherapy 106 References 106... 

Murakami M, Kuroda Y, Nishimura S, Sano A, Okamoto Y, Tanigu Nakajima T, Kobashi Y, Matsusue S (2001) Intraarterial infusion chemotherapy and radiotherapy with or without surgery for patient with locally advanced or recurrent breast cancer. Am J Clin Oncol 24 185 191... 

With the introduction of newer agents, patients with Stage D carcinoma of the bladder were treated at MDACC by a combination of intraarterial and intravenous chemotherapy (Logothetis et al. 1985). CISCA [cisplatin, Cytoxan, and doxorubicin (Adriamycin)]. Cytoxan (650 mg/m ) and Adriamycin (50 mg/m ) were delivered intravenously on the day the catheters were placed into each internal iliac artery and infused with heparinized saline. The next day, after adequate hydration, cisplatin ((70-100 mg/m ) was infused intraarterially along with mannitol (40 g) IV for diuresis. An overall complete remission rate of 50% and a partial response rate of 18% a total response rate of 68% was achieved (Fig. 9.14). 

In most patients with carcinoma of the cervix, the uterine arteries can be selectively catheterized after puncture of the contralateral femoral arteries. This is only of value if the neoplasm is confined to the cervix and the immediately adjacent area. More frequently, intraarterial therapy is delivered to patients with Stages 3 and 4 carcinoma of the cervix in whom the disease extends to the pelvic side walls, the vagina, the bladder, and the iliac lymph nodes. This necessitates infusion of both anterior divisions and, at times, the initial branches of the posterior divisions. The distribution can be confirmed by CT angiography and radionuclide studies. Because the flow rate used in the radionuclide flow study is similar to the chemotherapy infusion rate, the radionuclide flow study... 

LA. Infusion Our experience with percutaneous intraarterial transcatheter chemotherapy in patients with recurrent carcinoma of the vulva and penis is limited. Therapy is usually delivered through the internal pudendal branch of the internal iliac artery, the external pudendal branch of the external iliac artery, and the external pudendal branch of the deep femoral artery. The chemotherapy regimen consisted of mitomycin C (10 mg/m over 24 h), bleomycin (20-40 mg/m over 24 h), and dsplatin (100 mg/m over 2 h). Although the number of patients treated under this regimen is too small for analysis, dramatic responses have been observed in several patients. 

Embolization Hemorrhage from genitourinary neoplasms have been treated successfully by the intraarterial infusion of chemotherapy if the bleeding is chronic. 

Malawer M et al. (1991) Impact of two cycles of preoperative chemotherapy with intraarterial cisplatin and intravenous doxorubicin on the choice of surgical procedure for high-grade bone sarcomas of the extremities. Clin Ortho 270 214-222... 

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