Chapter 23: Administration of systemic anticancer therapies
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Evidence‐based approaches
Rationale
The tumour site determines which artery will be used to deliver the chemotherapy because it is the artery supplying the tumour that is cannulated. The most common route is the hepatic artery (Weinstein and Hagle [265]).
Indications
Intra‐arterial chemotherapy has been used to treat a variety of malignancies at many different sites. These include:
- head and neck lesions
- liver metastases from colorectal cancer
- sarcomas/melanomas of upper and lower limb (including isolated limb perfusion)
- carcinoma of the stomach
- carcinoma of the breast
- carcinoma of the cervix.
Methods of infusion
Two main methods are used for arterial infusional chemotherapy: external and internal.
The external method
This involves radiographic placement of an arterial catheter and attachment to an external infusion pump (Wilkes [268]). Temporary catheter placement is used for short‐term therapies, that is, from hours up to 5 days. Therapy can be given intermittently for several courses. This method is unsuitable for long‐term use (6 months or longer) as it is uncomfortable, inconvenient and expensive, although a subcutaneous implanted port increases the patient's comfort and freedom (Wilkes [268]).
Once the catheter is in place and secured, cytotoxic drugs may be administered by:
- injection, using a syringe
- small‐volume infusion, using a syringe pump.
- large‐volume infusion, using a volumetric pump.
Internal or implantable methods
These involve the surgical placement of a totally implantable pump and appear to have a lower complication rate than the external method. The catheter is inserted into an appropriate artery and attached to the pump, which is filled with chemotherapy. This approach is more frequently used for colorectal cancer metastases to the liver.
Confirmation that the artery supplies the desired area can be achieved by instillation of yellow fluorescent dye if the tumour site is visible, or contrast medium if an internal organ such as the liver is the target area.
All delivery systems must provide adequate pressure to combat arterial pressure, that is, 300 mmHg (Wilkes [268]). The majority of infusion pumps meet this requirement. Patient education is very important as the patient may have to maintain the implantable pump and be able to recognize any complications or malfunctions.
