Intra-arterial Therapy: A Review of its Clinical Applications in Malignant Disease

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Abstract
The whole subject of intra-arterial therapy in cancer is reviewed, and published experience of workers in this field summarised. Theoretical considerations of tumour type, clinical indications for treatment, agent to be used, refinements of administration technique, etc., have been discussed in an effort to define the purpose and value of intraarterial medication in clinical cancer therapy and in research. The limitations and complications of intraarterial methods have been discussed, and ideas have been sketched for techniques designed to augment systemic tolerance to such agents as are now available for intra-arterial administration. It is concluded that, in well selected cases the arterial tree (a natural channel through which a tumour obtains its nourishment and support), can be used with advantage for delivering substances which in some way will aid in the control or destruction of the neoplastic tissue. An intense local effort is obtainable which helps exploit the available total body tolerance to the therapeutic agent and which may be enhanced in the tumour by its abnormal vasculature and its altered permeability of border surfaces. Furthermore, by intra-arterial administration the range and the scope of such chemotherapeutic and cancericidal agents as are now available may be greatly extended. It is not suggested that intra-arterial therapy is a "new" treatment of malignant disease, but that it is a hitherto neglected therapeutic approach, and that it may offer definite possibilities in the palliation of the otherwise untreatable case, and perhaps a better clinical result in "early" cases when used as an adjuvant to standard therapeutic procedures. In addition, it offers unique opportunities for clinical research in cancer and in other fields. In capable hands, and with commonsense management, the slight risks and rare complications of the intra-arterial technique are certainly justifiable, especially in the treatment of advanced neoplastic disease.