When there is a need to give high doses of chemotherapy to a specific area of the body, it may be given by a regional method. Regional chemotherapy involves directing the anti-cancer drugs into the tumor-bearing part of the body.

The purpose of regional chemotherapy is to get more of the drug to the cancer than you can get by giving the drug so that it goes to the whole body, while minimizing side effects elsewhere. Examples of regional chemotherapy include drugs given into the body through these routes:

• Intra-arterial (into an artery that goes to a certain area of the body)
• Intravesical (into the bladder)
• Intrapleural (into the chest)
• Intraperitoneal (into the abdomen)
• Intrathecal (into the central nervous system via spinal fluid)

Intra-arterial infusions gained some popularity during the 1980s.

An intra-arterial infusion allows a chemotherapy drug to be given directly to the tumor through a catheter placed in the artery that supplies blood to the tumor. This method is used to treat disease in an organ such as the liver (isolated hepatic perfusion) or to treat an extremity such as the leg (isolated limb perfusion). The goal is to concentrate the drug in the areas of the tumor and decrease systemic effects.

The catheter is attached to an implanted or portable pump.

Although this approach sounds like a good idea for better effectiveness and fewer side effects, most studies have not found it to be as useful as was expected. This approach is still being studied in clinical trials. Except for these studies, it is rarely available outside of specialized cancer centers.

Intracavitary is a broad term used to describe chemotherapy given directly into a body cavity such as intravesical (into the bladder), intraperitoneal (abdominal cavity), or intrapleural (chest cavity between the lungs and chest wall) chemotherapy. The drug is given through a catheter placed directly into one of these areas.

Intravesical chemotherapy is often used for early stage bladder cancer.

For each treatment a urinary catheter is placed into the bladder to give the drug. The drug is kept in the bladder for about 2 hours and then drained.

The urinary catheter is removed after each treatment.

Intrapleural chemotherapy is not used very often but may be helpful for some people with mesothelioma (cancer that develops in the lining of the lung), and those with lung or breast cancers that have spread to the pleura (the membrane around the lungs and lining the chest cavity).

Intrapleural chemotherapy is given through large or small chest catheters that may be connected to an implantable port. These catheters can be used to give drugs as well as to drain fluid that can build up in the pleural space when cancer has spread to that area.

Intraperitoneal chemotherapy has become one of the standard treatments for certain stages of ovarian cancer. It may also be used to treat some recurrent colon cancers, as well as cancers of the appendix that have spread extensively within the abdomen.

Intraperitoneal chemotherapy is given through a Tenckhoff catheter (a catheter specially designed for removing or adding large amounts of fluid from or into the abdominal cavity) or through an implanted port attached to a catheter. Chemotherapy injected into the port travels through the catheter into the abdominal cavity where it is absorbed into the bloodstream.

This approach can work very well, but it can also have more severe side effects than regular IV chemotherapy.

Intrathecal chemotherapy is given directly into the fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) to reach cancer cells in the fluid and around the central nervous system. Most chemotherapy drugs that are given into veins are unable to cross the barrier between the bloodstream and the central nervous system (brain and spinal cord), called the blood-brain barrier.

Intrathecal chemotherapy is given by one of two methods:

• The chemotherapy is given by a lumbar puncture (spinal tap) daily or weekly into the space around the spinal cord.

• The second method uses a special device called an Ommaya reservoir, which is placed into the skull and has a catheter inserted into a ventricle (a space inside the brain filled with cerebrospinal fluid).

Chemotherapy is given this way when it is needed to treat cancer cells that have entered the central nervous system (this is called leptomeningeal spread). It is seen most commonly in leukemias, but also may happen with some lymphomas and advanced solid tumors like breast and lung cancers.

Intrathecal chemotherapy does not help when tumors have already started growing in the brain or spinal cord.