Intraarterial Chemotherapy

In the treatment of advanced tumors, higher rates of complete tumor response are difficult to achieve because of dose-limiting toxicity. In theory, much higher drug concentrations within a tumor can be achieved by delivering the drug directly to the tumor through its arterial blood supply. The theoretical advantage of intra-arterial chemotherapy over standard intravenous (IV) chemotherapy is that a higher concentration of the drug can be delivered directly to the tumor bed than to other organs, potentially allowing for greater tumor cell killing with lower toxicity. Depending on the amount of drug uptake by the tumor during this first pass, it is also possible to deliver to the tumor cells themselves a greater amount of drug using this route than can be achieved by the IV route. Dynamic vascular flow studies indicate that head and neck lesions are suited to the pharmacodynamic advantages of intra-arterial chemotherapy.56 The use of intra-arterial chemotherapy for head and neck cancer is not new but, despite good tumor responses, this form of therapy failed to become popular because of catheter-related complications and outcomes not significantly different from those achieved with chemotherapy administered systemically.

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