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The fundamental principles of intra-arterial infusion chemotherapy are thought to be increased local drug concentration and the "first-pass" effect. The concentration in the rest of the body can only be decreased if there is local elimination of the infused drug before reaching the systemic circulation. This is referred to as the "first-pass" effect. In the evaluation of "first-pass" effect, the uptake of liver after infusing 99mTc-human serum albumin (99mTc-HSA) in the hepatic artery by injecting the subcutaneously implanted silicon reservoir was compared with that obtained after intravenous administration of 99mTc-HSA. In order to remove the factor of portal infusion, each count of liver up take had been continued for only 24 seconds after starting the liver uptake. The results are as follows: for 24 cases excepting 6 cases with catheter obstruction, the mean i.a./i.v. ratio was 7.92 +/- 3.34 (range 3.25 to 17.25). Although the elimination rate of drugs in the liver varies with each drug, the infusion of intraarterial chemotherapy should be about 8 times more concentrative than intravenous administration on the "first-pass" effect.

A 46-year-old female, who had undergone a radical mastectomy for cancer of the breast 5 years previously at another institution presented a pleural effusion, in which malignant cells were detected, along with cervical lymph node metastasis. Although the patient initially responded to the H-CMcF regimen and intrathoracic injections of adriamycin (ADM), her condition subsequently was exacerbated, with metastasis occurring in the liver. A complete remission however, was achieved by local treatment, which included intrathoracic infusions of ADM and cis-platinum plus hepatic artery infusions of ADM and lipiodol, in addition to a systemic treatment consisting of a modification of the FEMP regimen employing UFT, CPA, MMC, and PDN, to which were added the immunopotentiators OK-432 and MPA. At present, 18 months after treatment, the patient is apparently disease free. The results obtained in this case suggest that even a distant metastasis can be controlled by aggressive local treatment for each metastatic lesion, in addition to a multidisciplinary treatment based mainly on intensive chemotherapy.