The Intraarterial Infusion of Chemotherapeutic Agents as “Basal” Treatment of Cancer: Evidence of Increased Drug Activity in Regionally Infused Tissues

Abstract

There is evidence from a number of centres that some forms of locally advanced and aggressive cancers which are difficult to eradicate by standard means can be reduced by the use 01 “basal” chemotherapy to a degree which will allow more certain tumour eradication by subsequent radiotherapy and/or surgery. Clinicians have been divided as to whether there is an advantage in giving the chemotherapeutic agents directly into a regional artery of supply where this is feasible, as opposed to their systemic administration. This paper documents supportive evidence that some and possibly many chemotherapeutic agents are more effective if given regionally into an artery of supply. There is a higher incidence of local side‐effects in the region infused, including loss of hair, inflammatory changes, and ulceration of the skin or mucosa of the region infused. After intraarterial infusion of tagged bleomycin (indium‐Ill bleomycin) into a limb, the radioactive isotope remained more concentrated in the limb infused than in the opposite limb for at least 24 hours. Systemic side‐effects, including bone‐marrow depression, are less frequent and less severe in patients given chemotherapeutic agents by intraarterial infusion than if the same doses of agents are given intravenously. There is now sufficient evidence of the value of basal chemotherapy used in this way to make it mandatory that medical oncologists and surgeons, working together, should plan controlled studies to determine the most appropriate applications of this technique of management.

Intraarterial chemotherapy as an adjuvant treatment in locally advanced gastric cancer

“…Systemic side effects, including bone-marrow depression and gastrointestinal manifestations, are less frequent and less severe when the chemotherapeutic regimen is given intraarterially as compared to same doses of agents given intravenously [27]. The results of the present study showed that intraarterial chemotherapy was not followed by severe toxicity probably because the doses were lower than those used in systemic chemotherapy.…”

Selective High-Dose Intra-Arterial Cisplatin as Palliative Treatment for Incurable Head and Neck Cancer

“…The experience of the first years of application of intra-arterial chemotherapy made clear that initial tumor resection and irradiation significantly influences the vascular provision of the tumors. Thus, a higher effect of the chemotherapeutics could be achieved in cases of application as initial therapy with no prior surgery or irradiation possibly impairing the blood supply of the tumor [29]. Specific indications for the current therapy cannot be stated at this point, since we examined a limited number of patients who received different numbers of chemotherapy cycles.…”

Neoadjuvant Intracarotid Chemotherapy for Treatment of Advanced Adenocystic Carcinoma of the Lacrimal Gland

“…Depending on the target organ, the extraction rate may result in drug delivery that is many times higher than that achieved with standard intravenous therapy, and simultaneously associated with limited systemic toxic effects. 7,17 In addition, neoadjuvant chemotherapy, chemotherapy given prior to the "primary" or definitive treatment, induces tumor cell necrosis and potentially minimizes dissemination of viable tumor cells during the subsequent surgical manipulation. Finally, induction chemotherapy may induce a reduction in tumor size, rendering the mass more amenable to surgery.…”

“…First, a very high dose of drug is delivered to the target area. 7,17 This potentially enhances tumor cell kills by increasing area-under-curve concentration and shifting the dose-response curve to the right. Second, systemic toxic effects may be limited if a high percentage of the drug is removed as it passes through the target capillary bed and the remainder is diluted in the systemic circulation.…”