The efficacy and safety of intra-arterial (IA) chemotherapy versus intravenous (IV) chemotherapy for malignant gliomas were studied. We searched eight electronic databases to identify relevant randomized controlled trials that compared IA chemotherapy with IV chemotherapy in patients with malignant gliomas. This study was conducted in compliance with the Quality of Reporting of Meta-analysis (QUORUM) guidelines. The quality of data was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Four eligible randomized controlled trials including 460 patients were retrieved. Comparing IA chemotherapy and IV chemotherapy for malignant gliomas, disease control rate, efficacy rate, 1-year, 2-year, and 3-year overall survival as well as grade 3/4 leukocytopenia, thrombocytopenia, and anemia were not statistically different. In conclusion, IA chemotherapy is not superior to IV chemotherapy in terms of efficacy and overall survival as a treatment for malignant gliomas.

Keywords:
Systematic review, Glioma, Intra-arterial chemotherapy, Randomized controlled trials
1.
Wilson CB: Chemotherapy of brain tumors by continuous arterial infusion. Surgery 1964;55:640-653.
2.
Owens G: Intraarterial chemotherapy of primary brain tumors. Ann NY Acad Sci 1969;159:603-607.
3.
Stewart DJ: Intra-Arterial Chemotherapyof Primary and Metastatic Brain Tumors.The Neurological Complications of Cancer Treatment. Boston, Butterworth-Heinemann, 1991, pp 143-170.
4.
Dropcho EJ: Intra-arterial chemotherapy for malignant gliomas; in Berger M, Wilson C (eds): The Gliomas. Philadelphia, Saunders, 1999, pp 537-547.
5.
Basso U, Lonardi S, Brandes AA: Is intra-arterial chemotherapy useful in high-grade gliomas? Expert Rev Anticancer Ther 2002;2:507-519.
6.
Jahnke K, Kraemer DF, Knight KR, Fortin D, Bell S, Doolittle ND, Muldoon LL, Neuwelt EA: Intra-arterial chemotherapy and osmotic blood-brain barrier disruption for patients with embryonal and germ cell tumors of the central nervous system. Cancer 2008;112:581-588.
7.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF: Improving the quality of reports of meta-analyses of randomized controlled trials: the quorom statement. Rev Esp Salud Publ 2000;74:107-118.
8.
Higgins Jpt GS: Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. 2011.
9.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ: Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-926.
10.
Brozek J, Oxman A, Schünemann H: Gradepro [computer program]. Version 3.6 for Windows, 2011.
11.
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH: Grade guidelines. 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401-406.
12.
Deeks JJ, Altman DG, Bradburn MJ: Statistical methods for examining heterogeneityand combining results from several studiesin meta-analysis. System Rev Health Care 2001; pp 285-312.
13.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JJ, Zaza S: Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.
14.
Wetmore SJ, Koike KJ, Bloomfield SM: Profound hearing loss from intravertebral artery cisplatin. Otolaryngol Head Neck Surg 1997;116:234-237.
15.
Chauveinc L, Sola-Martinez MT, Martin-Duverneuil M, Mazeron JJ, Faillot T, Cornu P, Capelle L, Delattre JY, Poisson M, Baillet F, Chiras J: Intra-arterial chemotherapy with ACNU and radiotherapy in inoperable malignant gliomas. J Neurooncol 1996;27:141-147.
16.
Iwadate Y, Namba H, Saegusa T, Sueyoshi K: Intra-arterial mannitol infusion in the chemotherapy for malignant brain tumors. J Neurooncol 1993;15:185-193.
17.
Shapiro WR, Green SB, Burger PC, Selker RG, VanGilder JC, Robertson JT, Mealey JJ, Ransohff J, Mahaley MJ: A randomized comparison of intra-arterial versus intravenous BCNU, with or without intravenous 5-fluorouracil, for newly diagnosed patients with malignant glioma. J Neurosurg 1992;76:772-781.
18.
Kochii M, Kitamura I, Goto T, Nishi T, Takeshima H, Saito Y, Yamamoto K, Kimura T, Kino T, Tada K, Shiraishi S, Uemura S, Iwasaki T, Kuratsu J, Ushio Y: Randomized comparison of intra-arterial versus intravenous infusion of ACNU for newly diagnosed patients with glioblastoma. J Neurooncol 2000;49:63-70.
19.
Silvani A, Eoli M, Salmaggi A, Erbetta A, Fariselli L, Boiardi A: Intra-arterial ACNU and carboplatin versus intravenous chemotherapy with cisplatin and BCNU in newly diagnosed patients with glioblastoma. Neurol Sci 2002;23:219-224.
20.
Imbesi F, Marchioni E, Benericetti E, Zappoli F, Galli A, Corato M, Ceroni M: A randomized phase III study: comparison between intravenous and intraarterial ACNU administration in newly diagnosed primary glioblastomas. Anticancer Res 2006;26:553-558.
21.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ: Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-926.
22.
McMahon AJ, O Dwyer PJ, Cruikshank A, McMillan D, Lowe G, Rumley A, O'Reilly D, Baxter JN: Metabolic changes after laparoscopic and minilaparoscopic cholecystectomy: a randomized trial. Br J Surg 1993;80:641-667.
23.
Choi CH: ABC transporters as multidrug resistance mechanisms and the development of chemosensitizers for their reversal. Cancer Cell Int 2005;5:30.
24.
Doolittle ND, Miner ME, Hall WA, Siegal T, Jerome E, Osztie E, McAllister LD, Bubalo JS, Kraemer DF, Fortin D, Nixon R, Muldoon LL, Neuwelt EA: Safety and efficacy of a multicenter study using intraarterial chemotherapy in conjunction with osmotic opening of the blood-brain barrier for the treatment of patients with malignant brain tumors. Cancer 2000;88:637-647.
25.
Sampson JH, Akabani G, Friedman AH, Bigner D, Kunwar S, Berger MS, Bankiewicz KS: Comparison of intratumoral bolus injection and convection-enhanced delivery of radiolabeled antitenascin monoclonal antibodies. Neurosurg Focus 2006;20:E14.
26.
Sampson JH, Brady ML, Petry NA, Croteau D, Friedman AH, Friedman HS, Wong T, Bigner DD, Pastan I, Puri RK, Pedain C: Intracerebral infusate distribution by convection-enhanced delivery in humans with malignant gliomas: descriptive effects of target anatomy and catheter positioning. Neurosurgery 2007;60:S89-S98, S98-S99.
27.
White E, Bienemann A, Pugh J, Castrique E, Wyatt M, Taylor H, Cox A, McLeod C, Gill S: An evaluation of the safety and feasibility of convection-enhanced delivery of carboplatin into the white matter as a potential treatment for high-grade glioma. J Neurooncol 2012;108:77-88.
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2013
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