Chemoembolization: transcatheter management of neoplasms

Abstract

"Chemoembolization," the combination of intra-arterial infusion of a chemotherapeutic agent and arterial embolization of the vascular supply to a neoplasm as proposed by Kato et al elsewhere in this issue (p 1123), presents an interesting concept with considerable potential. In addition to the direct effect of ischemia on the neoplasm by temporary occlusion, the emboli decrease the transit time through the tumor vascular bed, theoretically increasing the contact time of the chemotherapeutic agent with the neoplastic cell, increasing local drug concentration, and probably increasing tissue permeability because of the anoxia. The cytotoxic effect is not only on the neoplasm, but on the vessel embolized and infused, producing vasculitis and occlusion. The systemic toxic effect may be reduced by metabolism of the drug on its first passage through the infused organ, thereby confining the higher concentration of the chemotherapeutic agent to the target organ. There is considerable clinical support for each