Intra-arterial chemotherapy is a technique wherein medications are given into the artery supplying blood to the targeted tumor. These blood vessels are marked with the help of a dye by an x-ray technique. This is called angiography.

As of now, there are two techniques available for intra-arterial administration of drugs-

• Temporary external catheter: A temporary catheter is implanted in that particular artery which supplies blood to the tumor area. This is removed after the medication is administered. However, this should be done carefully and the site should be checked later for bleeding or any other symptoms.

• Implanted pump: A pump is implanted surgically in the subcutaneous tissue. The pump is removed after the chemotherapy is over. This technique is used to treat cancer of limb sarcoma, metastasized colon cancer spread to the liver, limb melanoma, pancreatic cancer head and neck, gastric cancer and some other types of cancers. The logic behind this is that the tumor would get exposed to the drug and the toxicity would be restricted to the tumor and the surrounding area unlike in systemic chemotherapy where the toxicity spreads to the entire body through the bloodstream.

Intra Arterial Chemotherapy for Liver Cancer

In normal cases, the liver gets its blood supply from two sources- 70% from the portal vein and 30% from the hepatic artery. In case of primary liver cancer or hepatoma or hepatocellular carcinoma (HCC), the liver gets its blood supply from only the hepatic artery. Hence, the chemotherapy drug is infused through the hepatic artery that directly attacks the tumor. Hypothetically, the advantage is that higher concentrations of the drug are delivered to the liver tumors without creating toxicity in the entire body that results in horrible side effects.

Benefits and Side Effects of Intra Arterial Chemotherapy

Although, logically and theoretically, this treatment may seem useful the ground reality is different. Most of the chemotherapy ends up in the rest of the body. Hence, technique also causes the same side effects like systemic chemotherapy. Also, this results in some local side effects like inflammation of the gallbladder i.e. cholecystitis, intestinal and stomach ulcers, and inflammation of the pancreas i.e. pancreatitis. Liver failure could result in case of liver cancer patients with advanced cirrhosis. Statistically, the fact is that less than 50% of the patients actually benefit from this treatment.

Procedure of Intra Arterial Chemotherapy

An interventional radiologist carries out this procedure by working closely with the oncologist. The oncologist determines the dose of chemotherapy drug for each session. These sessions could be repeated for some patients after 6- 12-weeks. This procedure is done with the help of fluoroscopy. A catheter is inserted into the femoral artery in the groin and threaded into the aorta from where it enters the hepatic artery. The hepatic artery and sub arteries that supply blood to the liver are identified and then the chemotherapy drug is infused. This process takes around 2 hours after which the catheter is removed. The patient has to be hospitalized and kept under observation to check for bleeding or any other complications that could possibly occur. Doctor also makes sure that the foot pulse is not blocked. There are certain symptoms like fever, abdominal pain and increased liver tests result for 2-3 days after this procedure. However, a severe abdominal pain or vomiting could indicate a complication and should be treated immediately. Liver tests and imaging is done again after 6-12 weeks to check the results of this procedure.

Intra arterial chemotherapy seems to be an extremely logical procedure. However, some improvisation is required to improve the results and decrease the side effects.