Regional Intra-arterial Chemotherapy Research Articles

Intra-arterial Chemotherapy in Patients With Metastatic Breast Cancer: A Scoping Review.

Breast cancer is a common malignancy in women, and the survival rate for this cancer is low once itmetastasized. Currently, chemotherapy is the first-line treatment for metastatic breast cancer (MBC). However, when liver metastases (LM) are present, the response to chemotherapy is poor. Regional intra-arterial chemotherapy (RIAC) delivers a high concentration of anticancer drugs to the malignant tissue, which improves the survival rate of patients with LM. It also decreases systemic side effects associated with chemotherapy. RIAC leads to higher remission rates becauseitdirectly targets the affected area. When RIAC is used alongside systemic chemotherapy, tumor resistance is decreased, increasing the rates of remission. This review aims to introduce the use of RIAC in patients with MBC. RIAC is a relatively new therapy in interventional oncology, and thus, limited research is currently available.

Results of comprehensive treatment of locally advanced oral cancer using regional intra-arterial chemotherapy

Introduction. Head and neck cancers are a significant healthcare and social problem worldwide with an estimated 377,713 new cases and 177,757 deaths registered annually. The incidence of head and neck cancer in Russia is 4.12 per 100,000. Despite all the achievements of current oncology, approximately 50–60 % of patients with locally advanced head and neck cancer develop relapses within the first 2 years after treatment completion.The study objective is to analyze the effectiveness of regional intra-arterial polychemotherapy in the combined and comprehensive treatment of locally advanced oral cancer.Materials and methods. This prospective study included 29 patients with oral squamous cell carcinoma treated and followed-up at N.N. Blokhin National Cancer Research Center between 2017 and 2020. The majority of patients (82.8 %) had stage III–IV disease. We evaluated clinical response to neoadjuvant regional intra-arterial chemotherapy, pathomorphosis of the primary tumor after surgery, treatment toxicity, overall survival, and relapse-free survival.Results. The objective response rate assessed for the primary oral tumor after regional intra-arterial chemotherapy was 100 %; complete regression of the primary tumor was achieved in 82.8 % of patients. More than one-third of participants (35.5 %) had complete regression of metastases in regional lymph nodes. In 73.5 % of patients who had under gone neoadjuvant regional intra-arterial chemotherapy followed by surgery, we observed grade IV therapeutic pathomorphosis of the primary tumor. The 2-year relapse-free survival rate was 100 % in individuals with stage II–III disease and 92.9 ± 6.9 % in patients with stage IV disease.Conclusion. The administration of regional intra-arterial chemotherapy as an induction stage ensures high treatment efficacy and high rate of complete pathomorphological responses. This suggests the opportunity of conservative treatment for patients with locally advanced oral cancer, which is currently considered impossible for such patients. Moreover, this method demonstrated moderate systemic toxicity, which expands the indications for its use and increase treatment compliance.

Results of conservative treatment of locally advanced larynx squamous cell carcinoma using intraarterial regional polychemotherapy

The study objective is to evaluate the results of organ-preserving treatment of locally advanced larynx squamous cell carcinoma.Materials and methods. Analysis of 28 patients with locally advanced larynx squamous cell carcinoma (stages III-IV) who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia between 2017 and 2020 was performed. At the first stage, 2-3 courses of combined inductive polychemotherapy per the DCF scheme with 21-day interval were performed (docetaxel 60 mg/m2, cisplatin 60 mg/m2 intraarterially bolus with detoxication with sodium thiosulfate, 5-fluorouracil 1000 mg/m2/day as 96-hour infusion). The second stage included external beam radiotherapy (60-70 Gy, 2 Gy per day 5 days a week) as monotreatment if complete clinical response after chemotherapy was achieved or with regional administration of cisplatin (60 mg/m2 once per 3 weeks) if after inductive stage full clinical response wasn»t observed.Results. In 20 (71.5 %) patients, complete clinical response was observed after inductive treatment; in 7 (25 %) patients, partial response was observed. Tumor stabilization was detected in 1 (3.5 %) patient. Two-year overall survival was 95.8 ± 4.1 %, progression-free survival was 90.1 ± 6.8 %.Conclusion. The proposed strategy of organ-preserving treatment of stage III-IV larynx cancer with substitution of systemic chemotherapy with regional intraarterial chemotherapy prior to radiotherapy is highly effective from the point of view of direct anti-tumor effect and recurrence-free and overall survival.

Endovascular implantation of iodine-125 seed strand combined and stent placement for locally advanced pancreatic ductal adenocarcinoma with vascular invasion: a prospective single-arm pilot study.

PurposeTo investigate the safety and feasibility of endovascular brachytherapy using iodine-125 (125I) seed strand for locally advanced pancreatic ductal adenocarcinoma (PDAC) with vascular invasion.Material and methodsFrom January 2010 to January 2015, 12 patients diagnosed with locally advanced, inoperable PDAC with splenic or superior mesenteric vein invasion were enrolled in the present study and received endovascular brachytherapy combined with regional intra-arterial infusion chemotherapy. Standardized software was used for dose calculation. Procedure-related and radiation complications were documented and assessed. Overall survival was calculated with the Kaplan-Meier approach.ResultsThe technical success rate of 125I seed strand implantation and stent placement was 100%. During follow-up with a mean duration of 17.00 ±6.07 months (range, 6~24 months), the mean and median survival times were 12.0 ±2.4 months (95% CI: 7.4~16.6 months) and 10.7 ±1.4 months (95% CI: 8.0~13.5 months), respectively. One month after the treatment, the disease control and objective rates were 83.8% and 58.3%, respectively. The 6-, 12-, and 15-month cumulative survival rates were 66.7%, 47.6%, and 9.5%, respectively.ConclusionsEndovascular brachytherapy using 125I seed strand and stent placement may be a safe and effective treatment option for locally advanced pancreatic duct adenocarcinoma with vascular invasion.

Organ preservation treatment of locally advanced cancer of the laryngopharynx using regional intra-arterial chemotherapy in a patient with solitary kidney

Introduction . Chemoradiation therapy with a competitive regimen allows to avoid laryngectomy and increase patients’ quality of life. However, it’s highly toxic and this limits the use of this approach in patients with severe concomitant disorders. The alternative to systemic chemotherapy is infusion of high doses of chemotherapy drugs directly into a vessel supplying the tumor through a microcatheter. The study objective is to present a clinical case of using intra-arterial chemotherapy for treatment of locally advanced laryngopharyngeal cancer in a patient with a solitary functioning kidney. Materials and methods . Patient K., 55 years old, applied to the Head and Neck Tumors Clinical of the N.N. Blokhin National Medical Research Center of Oncology with laryngopharyngeal cancer and bilateral metastases in the lymph nodes (T3N2M0, stage IV). Use of systemic chemotherapy for this patient was limited because he had only 1 functional kidney. Three (3) courses of intra-arterial chemotherapy with docetaxel and cisplatin 60 mg/m 2 (with detoxification with sodium thiosulfate) and subsequent radiation therapy, systemic infusion of 5-fluorouracil were performed. Results . The main side effect of the treatment was edema of the pharyngeal and laryngeal mucosa but without severe respiratory distress. The symptoms were corrected with inhalations of oxygen-hydrocortisone mixture. Laboratory and instrumental control during treatment didn’t show any deterioration of the state of the solitary functioning kidney. Conclusion . Regional intra-arterial chemotherapy demonstrated a satisfactory effect in a patient with severe concomitant pathology and absolute counterindications for systemic chemotherapy.

HIFU is safe, effective, and feasible in pancreatic cancer patients: a monocentric retrospective study among 523 patients.

PurposeThis study aimed to evaluate the clinical value of high-intensity focused ultrasound (HIFU) combined with gemcitabine (GEM) in treating unresectable pancreatic ductal adenocarcinoma (PDAC).Patients and methodsA total of 523 unresectable PDAC patients were recruited from December 30, 2007 to January 30, 2015 at Fudan University Shanghai Cancer Center. Among them, 347 received HIFU combined with GEM (with regional intra-arterial chemotherapy [RIAC] or with systemic chemotherapy) and the remaining patients received GEM only. Postoperative complications were observed, and overall survival was recorded.ResultsThe median overall survival of patients who received HIFU combined with GEM vs GEM alone was 7.4 vs 6.0 months (P=0.002); the 6-month, 10-month, 1-year, and 2-year survival rates for patients in these two groups were 66.3% vs 47.5% (P<0.0001), 31.12% vs 15.9% (P<0.0001), 21.32% vs 13.64% (P=0.033), and 2.89% vs 2.27% (P=0.78), respectively. In the combined therapy group, the most obvious survival benefits were obtained among patients who received HIFU plus RIAC and systemic chemotherapy (used in the intervals between RIAC treatments). There were no severe complications in patients undergoing HIFU treatment.ConclusionWe demonstrated the survival benefit of HIFU among PDAC patients treated with GEM. The benefit was most obvious in PDAC patients treated with HIFU plus RIAC and systemic chemotherapy.

Prognostic value of glypican-1 for patients with advanced pancreatic cancer following regional intra-arterial chemotherapy.

Regional intra-arterial chemotherapy (RIAC) is a potential alternative treatment for advanced pancreatic cancer (APC) with fewer adverse effects than other treatment options. However, specific biomarkers to determine the prognosis of patients with APC have thus far, been unsatisfactory. Glypican-1 (GPC1) in exosomes has been identified as an early diagnostic biomarker for pancreatic adenocarcinoma. The aim of the present study was to investigate whether the presence of GPC1 in extracellular vesicles (EVs) could serve as a predictor of RIAC outcome for patients with APC. EVs in circulation were isolated and the percentage of GPC1+ EVs was measured using flow cytometry. Compared with healthy individuals, the levels of GPC1+ EVs were significantly increased in patients with APC (P<0.01). Following RIAC treatment, the percentage of GPC1+ EVs was decreased (P=0.023). Furthermore, patients with APC exhibiting a greater decrease of GPC1+ EVs experienced improved overall survival (OS) rates. In summary, the present study provides insights into identifying GPC1 as a novel prognostic biomarker for patients with APC following RIAC treatment.

Review of the possibilities of regional intra-arterial chemotherapy in the treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses

In this literary review analyzed the possibilities of combination therapy in the treatment of locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, compares the frequency and nature of side effects in its different variants, assessed the effectiveness of intra-arterial chemotherapy in comparison with other methods. Combined treatment with the use of systemic chemotherapy allows not carry out massive surgical operations, but does not improve the long-term results of treatment. Regional intra-arterial chemotherapy has a number of advantages: improves the tumor response to treatment, long-term results, as well as expands the possibilities of organ-preserving treatment performance and, accordingly, improves the quality of life of patients. Another advantage is the possibility of a parallel use of detoxifier, which excludes the toxic effect, which is inherent in systemic chemotherapy. The implementation of this technology in a wide clinical practice is limited by the need for special equipment for interventional radiology and, consequently, the increased cost of treatment. However, the high efficiency of this method in the future is likely to lead to its active implementation in clinical practice.

Improved Survival in Patients with Resected Pancreatic Carcinoma Using Postoperative Intensity-Modulated Radiotherapy and Regional Intra-Arterial Infusion Chemotherapy.

BackgroundWe assessed the role of adjuvant intensity-modulated radiotherapy (IMRT) in combination with chemotherapy for pancreatic carcinomas after curative resection and identified prognostic factors related to pancreatic carcinoma after multidisciplinary treatment strategies.Material/MethodsPancreatic carcinoma patients (n=61) who received adjuvant radiotherapy after resection (median dose, 50.4 Gy) between 2010 and 2016 were retrospectively identified. Sixty patients received chemotherapy, including concurrent chemoradiotherapy (CCRT), systemic chemotherapy, and regional intra-arterial infusion chemotherapy (RIAC). The Kaplan-Meier method was used to measure the 3-year overall survival (OS) and disease-free survival (DFS) rates. Log-rank univariate analysis and multivariate Cox regression model analysis were used to identify prognostic factors.ResultsMedian follow-up time was 25.5 (range, 4.9–59.7) months. The 3-year OS and DFS rates were 31.0% and 16.1%, respectively. The median OS and DFS were 27.4 and 16.7 months, respectively. Multivariate analysis indicated that independent favorable predictors for OS were CCRT (p=0.039) and postoperative RIAC (p=0.044). Moreover, postoperative RIAC (p=0.027), and pre-radiotherapy CA19-9 ≤37 U/mL (p=0.0080) were independent favorable predictors for DFS. The combination of radiotherapy and chemotherapy was tolerated well by the patients, and no treatment-related death occurred.ConclusionsCombined IMRT and adjuvant chemotherapy appeared safe and effective for pancreatic carcinoma. CCRT was associated with improved survival with acceptable toxicity. We propose that radiotherapy could be a part of postoperative treatment, but it should be administered concurrently with chemotherapy. Adding RIAC was associated with improved OS and DFS and it could be integrated into the postoperative treatment regimen.

Gemcitabine-Based Regional Intra-Arterial Infusion Chemotherapy in Patients With Advanced Pancreatic Adenocarcinoma.

The present study was carried out to investigate the prognostic factors in patients who received intra-arterial infusion for advanced pancreatic cancer. In addition, the detailed procedure of intra-arterial infusion chemotherapy was described.A total of 354 patients with advanced unresectable pancreatic adenocarcinoma were recruited from January 2012, to April 2015, at Zhongshan Hospital Fudan University, Shanghai, China. Demographic and clinic characteristics of the patients were extracted from electronic medical records. Restricted cubic spline was used to assess the nonliner regression between baseline CA19-9 value and overall survival. Kaplan–Meier analysis and Cox proportional hazard models were used to estimate the association between overall survival and clinical characteristics.Of all 354 included patients, 230 (65%) were male (male/female ratio = 1.8), and 72 (20%) patients were diagnosed with detectable distant metastases. Pretreatment CA19-9 value of patients with metastases was significantly higher as compared to those with locally advanced cancer (median: 922.30 vs 357.00 U/mL, P = 0.0090). Totally 274 patients completed 1 cycle of intra-arterial infusion, whereas 80 patients received 2 or more cycles of the chemotherapy. For all the 354 patients, median OS was 7.0 months (95% CI: 6.0, 8.0 months) with a 6-, 12-, and 18-month survival rate of 0.48, 0.28, and 0.18, respectively. The median OS of patients, who received 1 cycle of intra-arterial infusion therapy, was 6.0 months (95% CI: 5.0, 8.0 months), which was similar to 7.0 months (95% CI: 6.0, 9.0 months) in patients who received 2 or more cycles. Restricted cubic spline revealed the nonline association between baseline CA19-9 and prognosis. The Cox proportional hazard model showed that age, CA19-9 baseline, CA19-9 value, and tumor location were significantly associated with the OS.In conclusion, the gemcitabine-based RIAC presented a potential treatment method for advanced pancreatic adenocarcinoma. Young age, pretreatment CA19-9 value <1000 U/mL, and tumor located at the head of pancreas indicated better response to the regional intra-arterial chemotherapy and better overall survival.

THE METHOD OF TREATMENT OF PATIENTS WITH LOCALLY-ADVANCED BREAST CANCER

A method of care of patients with locally-advanced breast cancer consisting of using regional selective intraarterial chemotherapy in the schedule of the complex (palliative) treatment is presented. Results of treatment showed an advantage in comparison with the application of traditional methods of the breast cancer treatment. The methodology on intra-arterial introduction of chemotherapeutic agents developed at Donetsk Regional Antitumoral Center and University clinic of Odessa showed its undisputable contribution into development of modern oncology through decrease of primary tumoral locus, transition from inoperable state into the state at which it is possible to perform the radical volume of surgical interference to patient. The special attention is paid to development of new methods of treating BC patients (regional forms of disease) with unfavorable factors for forecast of tumor growth.

Successful daptomycin lock therapy for implantable intra-arterial catheter infection in a patient with liver metastases of colon cancer

There are no data on how to manage implantable intra-arterial catheter (IAC) infections. We report the case of a patient with liver metastases of colon cancer treated by regional intra-arterial chemotherapy who presented a suspected IAC-related infection, in whom daptomycin systemic treatment and lock therapy allowed to cure the IAC infection.

Combinational therapy: New hope for pancreatic cancer?

Pancreatic cancer is a devastating disease with a low overall survival rate. Chemotherapy is the most common treatment for patients presenting with advanced pancreatic cancer. Gemcitabine achieves a modest improvement in overall survival and is the gold standard for advanced pancreatic cancer treatment. Capecitabine and S-1, derivatives of 5-fluorouracil (5-FU), offers minimal clinical benefits. Folfirinox represents a new and aggressive regimen that might benefit patients of metastatic pancreatic cancer with good performance status. Other chemotherapy drugs such as platinums and irinotecan do not provide significant improvement in overall survival, but have been used as part of combinational therapies. Comparing to systemically delivered chemotherapy, regional intra-arterial chemotherapy achieves higher local drug concentration in tumors with lower systemic drug toxicity, and may serve as a better treatment regimen. Although there have been progress made in chemotherapeutic strategies against pancreatic cancer, the overall survival is not significantly improved in the last decade. Recently, development of chemotherapy in combination with molecular targeted therapies holds great promise in pancreatic cancer treatment, especially in patients with metastatic disease. Growing bodies of preclinical and clinical evidences indicate that the combination of conventional modalities with specific molecular targeted therapy increase the efficacy of the monotherapy without an increase in toxicity. In this review, we summarized the current regimens of chemotherapy and molecular targeted therapy for advanced pancreatic cancer and highlighted the novel combinational treatments tested in recent clinical trials.

The impact of combined preoperative and postoperative regional intra-arterial infusion chemotherapy on the survival of low rectal cancer

直肠癌术后复发和转移制约着根治性切除后患者5年生存率的提高.术前区域动脉灌注化疗可提高进展期直肠癌的根治性切除率[1],术后区域动脉灌注化疗可抑制直肠癌根治性切除后盆腔局部复发和肝转移[2].笔者通过对术前辅助肠系膜下动脉及肝动脉灌注化疗、术后辅助双侧髂内动脉及肝动脉灌注化疗加常规静脉化疗的pT3-4N0-2M0期中低位直肠癌患者临床资料的回顾性分析,探讨手术前后联合区域动脉灌注化疗对直肠癌患者复发和远期生存的影响。

Continuous intra-arterial infusion chemotherapy as a palliative treatment for oral squamous cell carcinoma in octogenarian or older patients

We intend to determine the potential benefits and analyze the outcomes of regional intra-arterial infusion chemotherapy (IAIC) for the octogenarian and older patients with oral cancer. Eighteen patients with oral squamous cell carcinoma were included. They were 12 males and six females with ages ranging from 80 to 96 years. An implantable port-catheter system was used for catheterization. Using a portable pump, methotrexate was given continuously through the external carotid artery for a mean period of 5.5 days (range, 4-7 days) followed by weekly bolus of low dose (25mg) of methotrexate until the clinical condition was stabilized. During the first week of IAIC, all tumors began to reduce in size. Of them 11 (61%) had a complete clinical response and 7 (39%) achieved a partial clinical response, after a mean follow-up period of 26 months (range, 8-72 months). The one- and three-year survival rates were 87% and 56%, respectively. There were no catheter-related complications. The side effects were mild and tolerable. IAIC might be specially indicated for oral cancer elderly with co-morbidity since a radical surgery or extensive radiotherapy can be avoided, and offers an acceptable palliative treatment in such patients.

Distribution and slow-release characters of gemcitabine-loaded bovine serum albumin nanospheres in SD rats

Objective To detect safety,slow-release characters and targeting effects of two kinds of gemcitabine(GEM)-loaded bovine serum albumin nanospheres(mean particle diameters were 110 and 406 nm respectively)through tissue distribution in SD rats.Methods Thirty male SD rates were divided into 3 groups:(1)GEM group(n = 10);(2)110 nm GEM nanospheres group(n = 10);(3)406 nm GEM nanospheres group(n = 10).Pure GEM was used as the model drug,and SD rats as experimental model animal.The concentrations of GEM in blood plasma and various organs of SD rats were dynamically detected by high performance liquid chromatography(HPLC).Results Blood plasma GEM-time curve in GEM group was higher than the other two groups(P ＜ 0.05).The concentrations of GEM in targeting organs,including pancreas(155.59 μg/g),liver(43.57 μg/g)and spleen(35.27 μg/g),were significantly higher in 406 nm nanospheres group than the other two groups 6 h after administration,but those of GEM in heart(116.26 μg/g),lung(8.32 μg/g),kidney(92.10 μg/g),and muscles(81.58 μg/g)were similar to the other 2 groups(P ＞0.05).Conclusion 406 nm GEM-loaded serum albumin nanospheres had excellent targeting effect,slow-release character and safety,and could be applied to the treatment of pancreatic cancer by regional intra-arterial infusion chemotherapy. Key words: Gemcitabine; Nanoparticle; Albumin; Pancreatic carcinoma

Effects of preoperative regional intra-arterial chemotherapy on lymphatic metastasis of pancreatic head carcinoma.

Objective To evaluate the efficacy of preoperative regional intra-arterial chemotherapy (RIAC) in the treatment of resectable pancreatic head carcinoma. Methods The clinical data of 50 patients with resectable pancreatic head carcinoma who had been admitted to the Research Institute of Pancreatic Diseases of Fudan University from December 2006 to July 2007 were retrospectively analyzed. Patients were randomly divided into2 groups (n =25 in each group): patients in group A were treated with preoperative RIAC followed by regional pancreaticoduodenectomy, and patients in group B were treated with surgical procedure routinely. The lymphatic metastases in the 50 specimens of pancreatic head carcinoma were detected by histological examination with hematoxylin and eosin (HE) staining, and lymphatic micrometastases were detected by immunohistochemical method with staining of cytokeratin AE1/AE3 in 10 specimens with negative HE staining of the lymph nodes in each group. Results There was no significant difference in the incidence of complications, the length of hospital stay and the 1-, 2-year survival rates between the 2 groups (χ2 = 0.12, 2.88, P > 0.05). The incidence of positive lymph node metastasis in group A was 7.1% (52/734), which was significantly higher than 22.1% (118/532) in group B (χ2 = 60.01, P 0.05). Conclusions Preoperative RIAC is helpful in improving the prognosis of patients with resectable pancreatic head carcinoma by reducing the incidence of lymphatic metastasis and decreasing tumor stage. Key words: Pancreatic neoplasms; Lymphatic metastasis; Micrometastasis; Preoperative chemo-therapy

Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma.

Regional intra-arterial infusion chemotherapy (RIAC) has been more valuable to improve prognosis and quality of life of patients with inoperable pancreatic adenocarcinomas, and adjuvant RIAC plays an important role in prolonging survival and reducing risk of liver metastasis after radical resection of pancreatic cancer, but the effect of preoperative or multiple-phase RIAC (preoperative combined with postoperative RIAC) for resectable pancreatic cancers has not been investigated. In this prospective study, the effect of multiple-phase RIAC for patients with resectable pancreatic head adenocarcinoma was evaluated, and its safety and validity comparing with postoperative RIAC were also assessed. Patients with resectable pancreatic head cancer were randomly assigned to two groups. Patients in group A (n=50) were treated with new therapeutic mode of extended pancreaticoduodenectomy combined with multiple-phase RIAC, and those in group B (n=50) were treated with extended pancreaticoduodenectomy combined with postoperative RIAC in the same period. The feasibility, compliance and efficiency of the new therapeutic mode were evaluated by tumor size, serum tumor markers, clinical benefit response (CBR), surgical complications, mortality and toxicity of RIAC. The disease-free survival time, median survival time, incidence of liver metastasis, survival rate at 1, 2, 3 and 5 years were also observed. Life curves were generated by the Kaplan-Meier method. The pain relief rate and CBR in group A was 80% and 84% respectively. Serum tumor markers decreased obviously and tumors size decreased in 26% of patients after preoperative RIAC in group A. No more surgical complications, mortality or severe systemic side effects were observed in group A compared with group B. The incidence of liver metastasis in group A was 34% which was lower than 50% in group B. The disease-free survival time and median survival time in group A were 15.5 months and 18 months respectively. The 1-, 2-, 3- and 5-year survival rates were 54.87%, 34.94%, 24.51% and 12.25% respectively. There was no significant difference of survival time or survival rates between two groups. Multiple-phase RIAC is effective in combined therapy of resectable pancreatic head carcinomas by enhancing inhibition of tumor growth and reduction of liver metastasis, without negative effect on patients' safety or surgical procedure.

INTRA-ARTERIAL CHEMOTHERAPY AND ITS SIGNIFICANCE IN THE TREATMENT OF OROPHARYNGEAL CARCINOMA

In complex therapeutic algorithms for cancer, regional intra-arterial chemotherapy is usually used as an adjuvant and placed in the beginning of treatment. Clinical experience however shows that the achieved remission of malignant tumour illness after non-adjuvant chemotherapy is only temporary and short-lived. The illness progresses relatively quickly if the patient receives no further treatment and most clinical studies have not found any significant increase in life expectancy in oncological patients treated with this method. The question remains to what extent the poor results are due to the treatment method and its position in the therapeutic algorithm, and to what extent they are due to imperfect knowledge of molecular tumour genetics or inappropriate choice of the neoadjuvant intra-arterial chemotherapy We compared preliminary results of immunohistochemical examinations (detection and analysis of expression of proteins Ku 70, STAT 1,3,5 which take part in the regulation of cell cycle apoptosis and repair of damaged DNA, carried out before and after chemotherapy, suggest that depending on the effects of neoadjuvant intra-arterial chemotherapy and patient's survivance. An overview of intra-arterial neoadjuvant chemotherapy of head and neck is presented. Knowledge of cell cycle processes, especially apoptosis and repair of damaged DNA, could significantly influence the choice of the therapeutic algorithm and therapeutical effect.

Is it relevant that intra-arterial chemotherapy may be effective for advanced pancreatic cancer?

Unresectable pancreatic cancers have an extremely dismal prognosis and chemoresistant nature. The treatment of pancreatic cancer is still problematic. Gemcitabine is a promising new agent that has been studied recently for palliation of advanced pancreatic cancer. However, the response rates have been highly variable, and are often irreproducible. To improve this low response rate, various treatments are needed because no standard treatment exists. Intra-arterial chemotherapy is considered to take advantage of the first pass effect of the drug, generating higher local drug concentrations in tumor cells with lower toxicity. Regional intra-arterial chemotherapy may provide high levels of cytostatic concentrations within the tumor and, simultaneously, a low rate of systemic side effects compared with systemic administration of anti-neoplastic drugs. Intra-arterial chemotherapy has been introduced as an alternative treatment for advanced pancreatic cancer. Further clinical trials of this method should be subjected to a prospective randomized controlled study for advanced pancreatic cancer.