Intra-arterial infusion chemotherapy: clinical applications and current status of therapeutic effects on various malignant tumors

Intra-arterial infusion chemotherapy for various malignant tumors in order to improve the antitumor effects and to diminish the side effects has been performed in general since the 1950's. Numerous reports have shown favourable therapeutic effects followed by the development of the new anticancer agents. Although in recent years application of intra-arterial administration of anticancer agents alone has been limited to such target tumors as liver cancer because of application of mechanical arterial embolization using gelatin sponge cubes, attempts have been made to enhance the antitumor effect. In order to improve targeting and stagnancy of anticancer agents in the tumor area, drug delivery systems involving arrangement of the hemodynamics of the tumor area (balloon-occluded arterial infusion therapy, administration with vasoconstrictive agents such as noradrenaline or angiotensin II and/or as administration with various drug carriers (microcapsules, lipiodol, albumin microspheres, Degradable Starch Microspheres, liposomes, etc.) have been prepared and made available for clinical use with various tumors. Furthermore, development of totally implantable equipment of intra-arterial use for not only continuous infusion but one-shot injection of anticancer agents contributes to the treatment of patients longer and more frequently with less trouble. In the future intra-arterial infusion chemotherapy will have an important role for treatment of various malignant tumors, especially as one part of multimodal treatments, although the pharmacokinetics should be more fully-studied.