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Tumor Blood Flow and Systemic Shunting in Patients Receiving Intraarterial Chemotherapy for Head and Neck Cancer¹

Department of Internal Medicine, Division of Hematology/Oncology [R. H. W., B. R. M.]; Division of Nuclear Medicine [H. A. Z., J. H. T., J. W. K., J. E. S., S. R. P.]; and The Department of Otolaryngology [S. R. B.], The University of Michigan Medical Center, Ann Arbor, Michigan 48109

Radionuclide techniques have been used to estimate the systemic shunt and to quantitate blood flow to the tumor and a reference normal tissue in nine patients undergoing intraarterial chemotherapy for head and neck cancer. The systemic shunt was calculated as the percentage of pulmonary trapping of intraarterially injected ^99mTc-labeled macroaggregated albumin. The mean systemic shunt in the 12 separate arteries studied was 23 ± 13% (SE) (range 8–43%). Quantitative blood flow was determined from the slope of the washout curve of intraarterially injected ¹³³Xe. The mean tumor blood flow was 13.6 ± 6.7 ml/100 g/min, while the mean blood flow to the scalp was 4.2 ± 2.1 ml/100 g/min providing a mean tumor/normal tissue ratio of 3.9 ± 2.7. An estimate of blood flow distribution was obtained by calculating the ratio of counts/pixel in the tumor mass versus the remainder of the head as determined by single photon emission computed tomography following an intraarterial injection of ^99mTc-labeled macroaggregated albumin. The mean ratio of tumor to normal tissue perfusion by this technique was 5.6 ± 3.7. These techniques have allowed noninvasive determination of the blood flow parameters associated with intraarterial chemotherapy. At least part of the therapeutic advantage of regional chemotherapy in patients with head and neck cancer is due to a tumor/normal tissue blood flow ratio that favors drug delivery to the tumor contained within the infused volume.

¹ Supported in part by USPHS Grant 5-MO-1-RR-00042.

² To whom requests for reprints should be addressed, at Comprehensive Cancer Center, University of Alabama in Birmingham, University Station, Birmingham, AL 35294.

Received 2/19/85. Revised 3/31/86. Accepted 4/28/86.

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