Interventional Oncology

Session: Educational Exhibit Presentations - Station 6: Interventional Oncology

Review of Current Literature on Intra-arterial Chemotherapy in Nonoperative Cancers and Downstaging to Resection

Monday, March 6, 2023

5:20 PM – 5:25 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Tania Schiff, MD

Resident
Northwell Health

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

ST

Shima Tafreshi, MD

Resident
Northwell Health - NSUH/LIJ
Christopher D. Yeisley, MD (he/him/his)

Resident
Northwell Health
AN

Amir Noor, MD

Physician
New York University School of Medicine

Disclosure(s):

Tania Schiff, MD: No financial relationships to disclose

Christopher D. Yeisley, MD: No financial relationships to disclose

Learning Objectives:

Review challenges in the treatment of alimentary tract neoplasms.

Highlight the most recent literature on intra-arterial chemotherapy for nonoperative cancers and down staging to resection.

Background: The role of intraarterial chemotherapy (IAC) is well established in certain types of malignancy, such as retinoblastoma. However, its role in other types of tumors is less clear and often overlooked. The concept of IAC is based on local infusion of chemotherapy medications directly into the tumor blood supply to help increase concentration of the medication and decrease systemic side effects. Intravenous chemotherapy (IVC) is thought to be less effective than IAC because a considerable amount of drug binds to plasma proteins in the blood along its course and decreases the amount of biologically active free drug. In IAC, the drug–protein binding rate is much lower than with intravenous administration. The drug titer can be increased by 2 to 20 times and the curative effect increased by 4 to 10 times.

Clinical Findings/Procedure Details: Google Scholar and Cochrane Library were used to identify all papers pertaining to intraarterial chemotherapy and the alimentary tract. Studies were limited to those published from 2012-2022. A total of 9 studies were identified, which included 720 patients. Of these, 8 were single-center retrospective reviews and one was a case report. Objective response (OR) was defined as complete response (CR) + partial response (PR) on follow-up. The overall OR rate across the available studies was 76.6%. However, 3 studies did not include imaging follow-up as part of their study design. Unique benefits that were also evaluated included decreased dosage of analgesic medications (66.7%), improved weight gain (52.2%), improved dysphagia (67.7%), and closure of perianal fistulas (83.3%). Two studies looked at post-operative pathology following neoadjuvant IAC for gastric cancer. One showed a statistically significant decrease in pro-proliferation gene expression, tumor suppressor gene expression, and invasion-related gene expression following IAC. Another saw a neo-adjuvant postoperative pathological response rate of 46.1% and complete pathological remission in 2.2%.

Conclusion and/or Teaching Points: IAC for advanced stage alimentary tract cancers is an underutilized and potentially beneficial component of the Interventional Radiologists armamentarium. Further studies are needed to determine the optimum treatment regiment and patient population.