{
  "abstract": "Background Selective and superselective intra-arterial cerebral infusion (SIACI/SSIACI) delivers chemotherapy directly to tumor-supplying arteries, achieving high local drug levels with reduced systemic toxicity. Often combined with blood–brain barrier disruption (BBBd) to enhance penetration, these methods have been widely studied, yet a comprehensive evidence synthesis is lacking. This study systematically assesses the safety and efficacy of intra-arterial chemotherapy with BBBd for glioma treatment.Methods We searched PubMed, Embase, and Web of Science for studies on SIACI with BBBd in glioma patients. Safety outcomes included rates of cases with complications, procedure-related complications (major/minor), stroke, intracranial and intratumoral hemorrhage, and mortality. Efficacy was based on tumor response (complete, partial, stable disease, progression). A subanalysis of SSIACI-only cases was also conducted.Results Nine studies with 230 glioma patients were included. The pooled rate of cases with complications was 27.1% (95% CI 19.8% to 35.7%), with procedure-related complications occurring in 15.4% (95% CI 6.1% to 24.6%). Major and minor complication rates were 4.3% (95% CI 0.9% to 7.7%) and 9.7% (95% CI 1.0% to 18.7%), respectively. Stroke, intracranial hemorrhage, and intratumoral hemorrhage occurred in 3.1% (95% CI 0% to 6.1%), 0.5% (95% CI 0% to 3.2%), and 0.04% (95% CI 0% to 3%), respectively, with no procedure-related deaths reported. Pooled response rates were 10.4% complete (95% CI 0% to 21.5%), 24.2% partial (95% CI 14.3% to 34.1%), 38.2% stable disease (95% CI 21.5% to 54.9%), and 39.3% progression (95% CI 14.8% to 63.8%). Subanalysis of superselective infusions yielded comparable outcomes to the overall cohort.Conclusion The findings indicate that SIACI/SSIACI chemotherapy following BBBd is a feasible and safe approach for glioma treatment, demonstrating a favorable procedural risk profile and preliminary signs of efficacy. Further studies are warranted to validate these results and refine procedural protocols.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Christian Ferreira"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Márcio Yuri Ferreira"
    },
    {
      "affiliations": [
        "Federal University of Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Leonardo Januario Campos Cardoso"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil"
      ],
      "name": "João Paulo Liute Scarramal"
    },
    {
      "affiliations": [
        "Federal University of Rio Grande do Sul, Porto Alegre, Brazil"
      ],
      "name": "Alleh Nogueira"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Tamika Wong"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Sanskruti Bokil"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Faith Singh"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Sara Massimo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Olivia Albers"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Netanel Ben-Shalom"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Randy D’Amico"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "David Langer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "John Boockvar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA"
      ],
      "name": "Yafell Serulle"
    }
  ],
  "title": "Safety and efficacy of selective and superselective intra-arterial cerebral infusion with blood–brain barrier disruption for glioma: a systematic review and meta-analysis",
  "uid": "7ad54733-1a83-5139-97b4-fd6e3682046b"
}