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

我们对口腔癌进行了超选择性动脉插管化疗联合中等剂量适形放射治疗。通过股动脉途径超选择插管进行两次或三次顺铂(40 mg/体)的输注。适形放射治疗分3~5个端口进行，总剂量为30Gy.每日剂量为2.0Gy.采用CT和血管造影相结合的方法，在超选择性动脉内注射抗癌药的同时，用CT评价肿瘤的药物分布，并用动脉动态CT评价肿瘤的灌注量.在所选血管的CT上通过肿瘤增强识别供血血管后，根据肿瘤的位置，通过放置在每条动脉的微导管注射顺铂。术后评估组织病理学效果，并将其分为5级。动脉内缓慢灌注动态CT有助于检测肿瘤的范围。定性上，肿瘤较邻近正常组织强化早、强度强、消退快，动态CT对肿瘤范围的评估有一定价值。当存在多个供血器时，每个供血器的顺铂剂量可以根据每次血管注射CT增强的肿瘤百分比来确定。然而，定量数据在预测治疗效果方面没有提供额外的信息。这可能表明动脉化疗的疗效不受头颈部肿瘤的灌注的直接影响。

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.