Gobin Y P, Cloughesy T F, Chow K L, Duckwiler G R, Sayre J W, Milanese K, Viñuela F
Department of Radiology, B7-146A, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA.
Radiology. 2001 Mar;218(3):724-32. doi: 10.1148/radiology.218.3.r01mr41724.
To evaluate the cause of complications in intraarterial chemotherapy for brain tumors and validate a dosage algorithm based on arterial territory.
Four hundred sixty-two procedures were performed in 113 patients. Technique included pulsatile infusion of a chemotherapeutic agent. Dosage was calculated per hemisphere and divided per arterial territory according to a spatial dose fractionation algorithm based on the vascular territories of major cerebral arteries: middle cerebral artery, 60%; anterior cerebral artery, 20%; posterior cerebral artery, 15%; and perforator arteries, 5%. Hospital charts of all patients were retrospectively reviewed for complications, with specific attention given to the angiograms to determine a cause. Then, subgroup analysis of the chemotherapy protocol with the largest patient population was performed to evaluate predictors of complications.
Six (1.3%) complications were asymptomatic; 12 (2.6%), transient neurologic; three (0.6%), permanent minor neurologic; three (0.6%), permanent major neurologic; and 32 (7.0%), seizures. In the subgroup analysis, the hemispheric dose administered according to the algorithm was strongly predictive of seizure and neurologic deficit.
Neurotoxicity of intraarterial cerebral chemotherapy can be minimized by using pulsatile injection and the described spatial dose fractionation algorithm.
评估脑肿瘤动脉内化疗并发症的原因，并验证基于动脉区域的剂量算法。
对113例患者进行了462次手术。技术包括化疗药物的脉冲式输注。剂量按每侧半球计算，并根据基于大脑主要动脉血管区域的空间剂量分割算法按动脉区域划分：大脑中动脉，60%；大脑前动脉，20%；大脑后动脉，15%；穿支动脉，5%。对所有患者的医院病历进行回顾性审查以查找并发症，特别关注血管造影以确定原因。然后，对患者人数最多的化疗方案进行亚组分析以评估并发症的预测因素。
6例（1.3%）并发症无症状；12例（2.6%）为短暂性神经功能障碍；3例（0.6%）为永久性轻度神经功能障碍；3例（0.6%）为永久性重度神经功能障碍；32例（7.0%）为癫痫发作。在亚组分析中，根据算法给予的半球剂量强烈预测癫痫发作和神经功能缺损。
通过使用脉冲式注射和所述的空间剂量分割算法，可将脑动脉内化疗的神经毒性降至最低。
