Intraarterial chemotherapy for brain tumors by using a spatial dose fractionation algorithm and pulsatile delivery

PURPOSE: To evaluate the cause of complications in intraarterial chemothera py for brain tumors and validate a dosage algorithm based on arterial terri tory. MATERIALS AND METHODS: Four hundred sixty-two procedures were performed in 113 patients. Technique included pulsatile infusion of a chemotherapeutic a gent. Dosage was calculated per hemisphere and divided per arterial territo ry according to a spatial dose fractionation algorithm based on the vascula r territories of major cerebral arteries: middle cerebral artery, 60%; ante rior cerebral artery, 20%; posterior cerebral artery, 15%; and perforator a rteries, 5%. Hospital charts of all patients were retrospectively reviewed for complications, with specific attention given to the angiograms to deter mine a cause. Then, subgroup analysis of the chemotherapy protocol with the largest patient population was performed to evaluate predictors of complic ations. RESULTS: Six (1.3%) complications were asymptomatic; 12 (2.6%), transient n eurologic; three (0.6%), permanent minor neurologic; three (0.6%), permanen t major neurologic; and 32 (7.0%), seizures. In the subgroup analysis, the hemispheric dose administered according to the algorithm was strongly predi ctive of seizure and neurologic deficit. CONCLUSION: Neurotoxicity of intraarterial cerebral chemotherapy can be min imized by using pulsatile injection and the described spatial dose fraction ation algorithm.