頭頸部領域悪性腫瘍に対する抗癌剤動脈内投与法の臨床的研究
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During the last three years, sixty cases of the head and neck cancer were treated with seventy courses of regional arterial chemotherapy, including infusion, one shot injection, perfusion and a new method, i. e., infusion of anti-cancer agents into the regional artery and simultaneous removal of the equal amount of venous blood.The present report concerns with discussions of the technical aspects of regional arterial chemotherapy, together with its early results and complications.Following cases showed poor results; cases of recurrent cancer, cases irradiated with more than 6000 rads, cases of poor general condition, far advanced cases (excluding maxillary cancers) and cases with large metastases to the cervical lymphnodes.Regional arterial chemotherapy was effective for those cases in which irradiation therapy was effective and radical surgery was possible.Regional arterial chemotherapy was performed in combination with surgery and irradiation, since regional arterial chemotherapy alone was not very effective.In the maxillary and intra-oral cancers, it proved to be effective to inject radiosensitizing agents continuously when irradiation was performed. In these case, the relationship between radiation doses (D) and frequencies of intra-arterial infusion (T), at the time of tumor disappearance, was established as follows; D=11000T-0.24By combining irradiation with regional arterial chemotherapy, the extension of surgical procedures as well as the doses of irradiation was made minimal.For the advanced cases of laryngeal cancer, regional perfusion was done preoperatively, in order to avoid cancerous dissemination.Twenty-four cases of the head and neck cancer were treated with intra-arterial infusion of radioisotopes.In these cases, three discussions were done as follows:(1) The relation between the speed of infusion and the regional isotope concentration.When a radioisotope was infused rapidly, the regional concentration was rather high but it was maintained only for a short period.When a radioisotpe was infused slowly, the regional cocentration was a little higher than the level obtained by intra-venous administration.It was necessary to take one to two hours in order to maintain the level of concentration at double of that of the intra-venous administration.(2) Affinity of radioisotopes to the cancerous tissue.131I. RISA (Radioactive Iodinated human Serum Albumin) concentrated mainly to the heart, 131I. AA (Aggregated Albumin), 203Hg. MH (Hematoporphyrin-Na), 198Au. colloid and 197Hg. Neohydrin mainly to the liver and/or kidney, 99mTcO4 and 131I. MAA (Macro Aggregated Albumin)mainly to the areas of cancer.Fractionated “one shot” infusion will be suitable for such an agent as 131I. MAA in order to bring about the better results.(3) In order to reconfirm the exact site of the tip of the catheter, the use of 131I. MAA is highly recommended.
- 社団法人 日本耳鼻咽喉科学会の論文
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