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

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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.