Donegan W L
Surg Annu. 1975;7:137-73.
The experience with intraarterial infusion chemotherapy in the 24 years since its development has established that it is not a substitute for conventional methods of management. Its prime indications are for palliation of advanced and recurrent cancer unsuitable for irradiation or surgery or as an adjunct to the latter. Several specific observations are relevant to its use in the head and neck region: 1. With currently available antineoplastic agents more than half of the neoplasms in this region can be made to regress. Epidermoid carcinomas, the most frequent tumor of the head and neck, as well as less frequent carcinomas and sarcomas can be affected. 2. Regressions are usually incomplete and brief, lasting but a few months, and despite complete tumor regression microscopic cancer usually persists. Occasionally, unpredictably, and for uncertain reasons a regression is complete and permanent. Small, well-differentiated and exophytic (verrucous) epidermoid cancers appear most liable to such a response. 3. Temporary or permanent neurologic damage is the most distressing morbidity associated with treatment. This hazard can be minimized by avoiding infusion of the internal carotid artery and protection of the patient from embolism of air or particulate matter through catheters. 4. The combined use of two or more chemotherapeutic agents is promising as a means for increasing the frequency and possibly the duration of tumor regressions. 5. The value of infusion as an adjunct to irradiation or surgery for potentially curable cancers is still unproved. Uncontrolled data suggest that local control of cancer may be improved, particularly if all three modalities are combined. A controlled clinical trial by experienced investigators could resolve this issue. 6. Although the arterial route increases the activity of some chemotherapeutic agents, significant progress appears to depend upon the development of drugs with greater specificity for neoplastic tissues. 7. In its present form, arterial infusion chemotherapy offers a brief period of palliation to many patients with cancer of the head and neck who are otherwise untreatable, and occasionally to such individuals a final chance for cure.
自动脉内灌注化疗开展24年以来的经验表明，它不能替代传统的治疗方法。其主要适应证是用于缓解不适于放疗或手术的晚期和复发性癌症，或作为放疗或手术的辅助手段。有几个具体的观察结果与它在头颈部区域的应用相关：1. 使用目前可用的抗肿瘤药物，该区域一半以上的肿瘤可实现消退。头颈部最常见的肿瘤——表皮样癌，以及较罕见的癌和肉瘤均可受到影响。2. 消退通常不完全且短暂，仅持续数月，尽管肿瘤完全消退，但显微镜下癌通常仍会持续存在。偶尔，不可预测且原因不明地会出现完全且永久性的消退。小的、高分化且外生性（疣状）表皮样癌似乎最容易出现这种反应。3. 暂时性或永久性神经损伤是与治疗相关的最令人痛苦的并发症。通过避免颈内动脉灌注以及保护患者免受空气或颗粒物质通过导管造成的栓塞，可将这种风险降至最低。4. 联合使用两种或更多种化疗药物有望增加肿瘤消退的频率，并可能延长其持续时间。5. 对于潜在可治愈的癌症，灌注作为放疗或手术辅助手段的价值仍未得到证实。未经对照的数据表明，癌症的局部控制可能会得到改善，特别是如果将这三种治疗方式联合使用。由经验丰富的研究人员进行的对照临床试验可以解决这个问题。6. 尽管动脉途径可增加某些化疗药物的活性，但显著进展似乎取决于开发对肿瘤组织具有更高特异性的药物。7. 以目前的形式，动脉灌注化疗为许多原本无法治疗的头颈部癌症患者提供了短暂的缓解期，偶尔也为这些患者提供了最后的治愈机会。
