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

Radiology. 2001 Mar;218(3):724-32. doi: 10.1148/radiology.218.3.r01mr41724.


Purpose: To evaluate the cause of complications in intraarterial chemotherapy for brain tumors and validate a dosage algorithm based on arterial territory.

Materials and methods: Four hundred sixty-two procedures were performed in 113 patients. Technique included pulsatile infusion of a chemotherapeutic agent. Dosage was calculated per hemisphere and divided per arterial territory according to a spatial dose fractionation algorithm based on the vascular territories of major cerebral arteries: middle cerebral artery, 60%; anterior cerebral artery, 20%; posterior cerebral artery, 15%; and perforator arteries, 5%. Hospital charts of all patients were retrospectively reviewed for complications, with specific attention given to the angiograms to determine a cause. Then, subgroup analysis of the chemotherapy protocol with the largest patient population was performed to evaluate predictors of complications.

Results: Six (1.3%) complications were asymptomatic; 12 (2.6%), transient neurologic; three (0.6%), permanent minor neurologic; three (0.6%), permanent major neurologic; and 32 (7.0%), seizures. In the subgroup analysis, the hemispheric dose administered according to the algorithm was strongly predictive of seizure and neurologic deficit.

Conclusion: Neurotoxicity of intraarterial cerebral chemotherapy can be minimized by using pulsatile injection and the described spatial dose fractionation algorithm.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Antineoplastic Agents / administration & dosage
  • Astrocytoma / drug therapy
  • Brain Neoplasms / drug therapy*
  • Cerebral Arteries
  • Child
  • Child, Preschool
  • Female
  • Glioblastoma / drug therapy
  • Humans
  • Infusions, Intra-Arterial / adverse effects*
  • Male
  • Middle Aged
  • Pulsatile Flow


  • Antineoplastic Agents