Intraarterial chemotherapy for brain tumors by using a spatial dose fractionation algorithm and pulsatile delivery.
OBJECTIVE
To evaluate the cause of complications in intraarterial chemotherapy for brain tumors and validate a dosage algorithm based on arterial territory.


METHODS
Four hundred sixty-two procedures were performed in 113 patients. Technique included pulsatile infusion of a chemotherapeutic agent. Dosage was calculated per hemisphere and divided per arterial territory according to a spatial dose fractionation algorithm based on the vascular territories of major cerebral arteries: middle cerebral artery, 60%; anterior cerebral artery, 20%; posterior cerebral artery, 15%; and perforator arteries, 5%. Hospital charts of all patients were retrospectively reviewed for complications, with specific attention given to the angiograms to determine a cause. Then, subgroup analysis of the chemotherapy protocol with the largest patient population was performed to evaluate predictors of complications.


RESULTS
Six (1.3%) complications were asymptomatic; 12 (2.6%), transient neurologic; three (0.6%), permanent minor neurologic; three (0.6%), permanent major neurologic; and 32 (7.0%), seizures. In the subgroup analysis, the hemispheric dose administered according to the algorithm was strongly predictive of seizure and neurologic deficit.


CONCLUSIONS
Neurotoxicity of intraarterial cerebral chemotherapy can be minimized by using pulsatile injection and the described spatial dose fractionation algorithm.
Department of Radiology, B7-146A, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA. pgobin@mednet.ucla.edu
Y P
YP
Gobin
T F
TF
Cloughesy
K L
KL
Chow
G R
GR
Duckwiler
J W
JW
Sayre
K
K
Milanese
F
F
Viñuela
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001254:Astrocytoma / Q000188:drug therapy; D001932:Brain Neoplasms / Q000188:drug therapy*; D002536:Cerebral Arteries; D002648:Child; D002675:Child, Preschool; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow
D000970:Antineoplastic Agents