Safety and efficacy of selective and superselective intra-arterial cerebral infusion with blood-brain barrier disruption for glioma: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Complete response 10.4%, partial response 24.2%, stable disease 38.2%

• Primary Outcome: Overall complication rate 27.1% (95% CI 19.8% to 35.7%)

• Nnt Or Sensitivity: Disease control rate (complete + partial + stable) approximately 72.8%

• Confidence Interval: Major complications 4.3% (95% CI 0.9% to 7.7%)

Clinical Application

Requires specialized neurointerventional expertise and infrastructure, limited to tertiary centres Would be restricted to major neurosurgical centres with interventional neuroradiology capabilities; not currently PBS-funded; requires multidisciplinary team approach consistent with Cancer Australia guidelines Patients with glioma suitable for intra-arterial access, likely recurrent or refractory cases

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.

References

1. 1.Ferreira, C., Ferreira, M. Y., Cardoso, L. J. C., Scarramal, J. P. L., Nogueira, A., Wong, T., Bokil, S., Singh, F., Massimo, S., Albers, O., Ben-Shalom, N., D'Amico, R., Langer, D., Boockvar, J., & Serulle, Y. (2026). Safety and efficacy of selective and superselective intra-arterial cerebral infusion with blood-brain barrier disruption for glioma: A systematic review and meta-analysis. Journal of Neurointerventional Surgery. https://doi.org/10.1136/jnis-2025-024057