What's New Intra-arterial Chemotherapy at Presbyterian Hospital, Dallas

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What's New Intra-arterial Chemotherapy at Presbyterian Hospital, Dallas
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What is Intra-arterial chemotherapy?
The arteries that supply blood to the brain, and to a brain tumor, carry oxygenated blood from the heart and lungs. Although all drugs are, in fact, delivered to the brain by the arteries, intra-arterial chemotherapy (IAC) involves the placement of a catheter directly into the artery feeding the tumor. This provides a higher concentration of the drug closer to the tumor.


Dr. Don Frei examines arteriograms.

What are the advantages of intra-arterial chemotherapy?
Some chemotherapy agents, because of their chemical makeup, have better penetration into the brain than others. It is often seen, for example, that a patient undergoing successful treatment for lung or breast cancer will nevertheless develop brain metastases. The so-called "blood-brain barrier" prevents many drugs from reaching concentrations that would kill tumor cells.

The blood-brain barrier can be overcome by a number of techniques, including chemical modification of chemotherapy drugs; "opening" the blood-brain barrier temporarily with drugs that are given immediately prior to chemotherapy; and increasing the concentration of the drug in close proximity to the tumor cells. Injecting a drug directly into the artery supplying the tumor may both increase the concentration of the drug where it is needed and decrease the exposure to the rest of the organs of the body.

What are the disadvantages of intra-arterial chemotherapy?
Intra-arterial chemotherapy requires insertion of a long cathether directly into the arteries of the brain, under X-ray guidance. This obviously requires a great deal of expertise in the interpretation of brain scans, X-rays of the arteries (arteriograms), and the manipulation of catheters within the high-pressure arterial vessels. The procedure requires anesthesia, drugs to prevent seizures during or after the procedure, and blood-thinners during the procedure to prevent stroke. The most significant risk of IAC is the potential for hemorrhage or stroke, either from anticoagulation drugs during the procedure or creation of tiny clots in the circulation following the procedure. In addition, there are unique risks of this form of chemotherapy, beyond the usual side effects of chemotherapy such as nausea and low blood counts. Some drugs used in the past caused damage to the normal parts of the brain fed by the same artery.

With those risks, why would intra-arterial chemotherapy be recommended?
Some specialists around the country who have used IAC for several years believe that this is the most effective form of treatment for tumors resistant to other forms of treatment, based on the longer survival seen and ability to continue chemotherapy even in patients who have had low blood counts as a result of previous treatment.

What kind of tumors are best treated with IAC?
A number of different tumor types have been treated, but the most common is malignant glioma (anaplastic astrocytoma and glioblastoma multiforme). For several years, IAC treatment of primary central nervous system lymphoma has been studied at the University of Oregon by Dr. Ed Neuwelt.

What drugs are given with IAC?
Most centers now use carboplatin, but several others, including cisplatin and BCNU, have also been used.

How often is IAC done?
Usually every four to six weeks.

Why don't more hospitals offer this form of treatment?
IAC requires a team of interventional radiologists, oncologists, and technicians. Specialized equipment is necessary to perform the procedure safely. While many centers around the country offer this form of treatment, it has not yet become "standard" therapy for any tumor.

Why must patients be admitted for the procedure?
The patient is given intravenous fluid and medications prior to the procedure and is given anesthesia before the procedure which prevents any discomfort. The catheter used in the procedure is inserted in the patient's groin artery and removed at the end of the procedure. Pressure is applied at this artery to prevent bleeding and the patient is allowed to recover in the hospital overnight to evaluate for any complications.

Will insurance cover the procedure?
In most cases, yes.

How can I find out more about the procedure?
To find out whether intra-arterial chemotherapy may be right for you, ask your physician. He or she may contact the Interventional Radiology Department at Presbyterian Hospital, Dallas, to submit your records and MRI scans for review. You will probably receive a response within 1-2 weeks.

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