Intraarterial therapies

Regional therapy is designed to augment local treatment effects while minimizing systemic adverse effects.

The predominant targets of intra-arterial therapy are primary and secondary liver cancers.

The physiological basis for liver directed intra-arterial therapies relies on the dual hepatic blood supply.

The hepatic parenchyma is normally is supplied primarily by the portal circulation with 75 to 80% of its supply, where the blood supply to highly vascularized malignant hepatic cells is almost exclusively derived from the hepatic artery.

By taking advantage of the differential blood flow between normal hepatic tissue and the malignant tissue, the goal of intra-arterial therapy is to maximize the delivery of cytotoxic agents to the tumor while minimizing toxicity is the background liver.

Intra-arterial therapies include: transarterial chemoembolization, transarterial embolization, yttrium-90 radioembolization, and hepatic artery infusion.

The most widely used intraarterial therapy is conventional transarterial chemo embolization (TACE) employs a cocktail of chemotherapy agents most commonly doxorubicin or platinum, suspended in a ethiodized oil, the Lipiodol, followed by the administration of additional emboli particles.

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