Supraophthalmic carotid infusion for brain chemotherapy

Jp, Kapp; Jl, Parker; Em, Tucker

doi:10.3171/jns.1985.62.6.0823

Cited by 17 publications

(3 citation statements)

References 4 publications

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“…In clinical practice, the tip of a superselective catheter is usually placed in the A1 segment of the anterior cerebral artery, the M1 segment of the middle cerebral artery, or in the posterior communicating artery (182). Supraophthalmic carotid infusion became the preferred procedure to prevent drugs from entering the eye (184,(186)(187)(188)(189)(190)(191). Flow-directed soft-tipped balloon or singlelumen catheters (188) with an extended tip (182-184) can be remotely controlled by hydraulic forces (189) and allow to maneuver even in extremely curved skull base vessels (184).…”

Section: Siacimentioning

confidence: 99%

“…Supraophthalmic carotid infusion became the preferred procedure to prevent drugs from entering the eye (184,(186)(187)(188)(189)(190)(191). Flow-directed soft-tipped balloon or singlelumen catheters (188) with an extended tip (182-184) can be remotely controlled by hydraulic forces (189) and allow to maneuver even in extremely curved skull base vessels (184). It has been reported that supraophthalmic carotid chemotherapy can be used to treat malignant gliomas with low dose cisplatin and BCNU (182,191,192), and that the pharmacokinetic changes of 11 C-BCNU are consistent with the metabolic changes captured by PET (185).…”

Section: Siacimentioning

confidence: 99%

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Strategies for Improved Intra-arterial Treatments Targeting Brain Tumors: a Systematic Review

2020

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Conventional treatments for brain tumors relying on surgery, radiation, and systemic chemotherapy are often associated with high recurrence and poor prognosis. In recent decades, intra-arterial administration of anti-cancer drugs has been considered a suitable alternative drug delivery route to intravenous and oral administration. Intra-arterial administration is believed to offer increasing drug responses by primary and metastatic brain tumors, and to be associated with better median overall survival. By directly injecting therapeutic agents into carotid or vertebral artery, intra-arterial administration rapidly increases intra-tumoral drug concentration but lowers systemic exposure. However, unexpected vascular or neural toxicity has questioned the therapeutic safety of intra-arterial drug administration and limits its widespread clinical application. Therefore, improving targeting and accuracy of intra-arterial administration has become a major research focus. This systematic review categorizes strategies for optimizing intra-arterial administration into five categories: (1) transient blood-brain barrier (BBB)/blood-tumor barrier (BTB) disruption, (2) regional cerebral hypoperfusion for peritumoral hemodynamic changes, (3) superselective endovascular intervention, (4) high-resolution imaging techniques, and (5) others such as cell and gene therapy. We summarize and discuss both preclinical and clinical research, focusing on advantages and disadvantages of different treatment strategies for a variety of cerebral tumor types.

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Section: Siacimentioning

confidence: 99%

Section: Siacimentioning

confidence: 99%

Strategies for Improved Intra-arterial Treatments Targeting Brain Tumors: a Systematic Review

2020

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“…Intermittent infusion of chemother apeutic drugs into the carotid artery has long been used as an experimental approach to the treatment of brain tumors. The drug most commonly infused into the carotid artery is 1,3-bis-chloroethylni trosourea (BCNU) (Greenberg et al, 1984;Hoch berg et al, 1985;Kapp et al, 1985). Our group is conducting a trial of continuous infusion of the ra diosensitizing drug 5' -bromodeoxyuridine (BUdR) for malignant gliomas (Greenberg et al, 1988).…”

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confidence: 99%

Mixing in the Human Carotid Artery during Carotid Drug Infusion Studied with PET

Junck

Koeppe

Greenberg

1989

J Cereb Blood Flow Metab

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Summary:The safety and efficacy of drug infusion into the carotid artery require adequate mixing of the infused solution with carotid blood. Using positron emission to mography (PET), we studied the mixing of solutions in fused into the human carotid artery in seven patients by analyzing the distribution of [150]H20 infused into the carotid artery and by vein. At four infusion rates ranging from 0.5 to 10 ml/min, the variability in distribution av eraged 16.5-17.8% among the pixels in a large volume of interest, without dependence on the infusion rate. The overall correlation between [150]H20 influx with arterial infusion and [150]H20 influx with venous injection was 0.78-0.82 at the four infusion rates, with no trend toward higher correlations at the faster infusion rates. The dis tribution into the anterior, middle, and posterior cerebral

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Intra-arterial Cisplatin--Associated Optic and Otic Toxicity

Maiese

Walker²,

Gargan³

et al. 1992

Archives of Neurology

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\s=b\Over a 22-month period, we investigated optic and otic toxicity accompanying i ntra\x=req-\ arterial cisplatin therapy. Baseline and serial neurologic and ophthalmologic examinations, visual evoked potentials, and brain\x=req-\ stem auditory evoked potentials were performed in six patients, aged 37 to 53 years. Patients received infraophthalmic intra-arterial cisplatin (60 mg/m2) every month for three to 10 treatments (mean, six treatments). Five of the six patients had progressive optic toxicity. In two patients, the visual evoked potential prolongation preceded acuity loss by at least 4 months. Two patients had evidence of otic toxicity by either brain\x=req-\ stem auditory evoked potential or click threshold and brain-stem auditory evoked potential. Intra-arterial cisplatin neurotoxicity may be significant in patients with already limited survival. Visual evoked potential and brain-stem auditory evoked potential should be used to monitor patients receiving potentially neurotoxic therapy.{Arch Neurol. 1992;49:83-86)f~~* isplatin (ris-dichlorodiammine platinum [III) is used to treat both sys¬ temic and central nervous system (CNS) malignancies. It has a significant role in the treatment of testicular, ovar¬ ian, adrenal, lung, and bone tumors.1 Cisplatin is also employed as an agent against neoplasms of the CNS. Some investigators have shown intra-arterial therapy to be efficacious in the treat¬ ment of malignant cerebral tumors.2The administration of cisplatin is lim¬ ited by its toxic effects. Nephrotoxicity,35 nausea, vomiting,11''7 myelosuppression,8,9 and peripheral neuropathy1""'2 occur frequently. Less commonly, systemic administration of cisplatin results in neurosensory hear¬ ing loss,13"1" optic neuritis,16 optic disc edema, ' ' cortical blindness,1S altered col¬ or vision,19 papilledema,16 encephalopa¬ thy,2921 and seizures. 22'23

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Supraophthalmic carotid infusion for brain chemotherapy

Cited by 17 publications

References 4 publications

Strategies for Improved Intra-arterial Treatments Targeting Brain Tumors: a Systematic Review

Strategies for Improved Intra-arterial Treatments Targeting Brain Tumors: a Systematic Review

Mixing in the Human Carotid Artery during Carotid Drug Infusion Studied with PET

Intra-arterial Cisplatin--Associated Optic and Otic Toxicity

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