Intraarterial Infusion Chemotherapy for Head and Neck Cancers: Evaluation of Tumor Perfusion with Intraarterial CT during Carotid Arteriography with a Combined CT and Angiography System

我们采用超选择性动脉灌注化疗联合中剂量适形放疗治疗口腔癌。经股动脉入路微导管超选择性置管，两次或三次输注CDDP （40mg/体）。适形放疗按3 ~ 5个端口规划，总剂量为30Gy，每日剂量为2.0Gy。在动脉注射造影剂进行超选择性动脉灌注抗癌药物时，我们通过CT评估肿瘤内的药物分布，并使用CT和血管造影联合系统，通过动脉动态CT评估肿瘤内的灌注情况。在选定血管的CT上通过肿瘤增强识别供血血管后，根据肿瘤位置，通过放置在各动脉的微导管注射顺铂。术后进行组织病理学观察，并将其分为5级。动脉内慢速灌注动态CT可用于检测肿瘤的范围。定性评价中，肿瘤较邻近正常组织增强早、强化强、洗脱快，动态CT可用于评价肿瘤的范围。当存在多个给药器时，每个给药器的顺铂剂量可通过每次血管注射CT增强肿瘤的百分比来确定。然而，定量数据并没有为预测治疗效果提供额外的信息。这可能表明动脉化疗的有效性不受头颈部肿瘤灌注的直接影响。

We have performed superselective intraarterial infusion chemotherapy for the cancer of the mouth combined with medium dose conformal radiotherapy. Two or three infusions of CDDP (40mg/body) are performed with superselective catheterization of a microcatheter via the femoral artery approach. The conformal radiotherapy is planned by three to five ports and the total and daily doses delivered are 30Gy and 2.0Gy, respectively.We evaluated drug distribution in the carcinomas with CT during intraarterial contrast-material injection for superselective intraarterial infusion of the anti-cancer agents, and to evaluate the perfusion in the carcinomas with intraarterial dynamic CT, using a combined CT and angiography system. After the feeding vessels were identified by enhancement of the tumor on CT of the selected vessel, cisplatin was injected through the microcatheter placed in each artery depending on tumor location. Histopathologic effects were evaluated after surgery and classified into five grades.The intraarterial, slow-infusion dynamic CT was useful for detection of the extent of the tumor. In the qualitative evaluation, tumors showed early and strong enhancement as well as rapid washout comparing to the adjacent normal tissues, and dynamic CT was useful for evaluation of the extent of the tumor. When multiple feeders existed, the dose of cisplatin for each feeder could be determined by the percentage of tumor enhanced with CT on each vascular injection. However, quantitative data did not provide additional information in prediction of the treatment effect. This might indicates that the effectiveness of intraarterial chemotherapy is not directly affected by the perfusion of the head and neck cancers.