Experiences with intra‐arterial chemotherapy for head and neck cancer

Hambly

1981

Cancer

Since the linear accelerator was installed in Sydney Hospital in 1964, 27 patients who presented with previously untreated but advanced deep carcinoma of the lower lip have been treated with initial megavoltage or orthovoltage radiotherapy with or without follow-up surgery. In 17 of these, the tumor appears to have been eradicated, but in the other ten (approximately one-third), the tumor was not controlled. These results are similar to those reported from other major centers. Since January, 1974, six patients with the most advanced lesions have been treated with "basal" chemotherapy (in four cases given intra-arterially and in two cases given intravenously) prior to radiotherapy. Follow-up surgery in the form of block dissection was required in one patient, and wedge resection of a residual focus of tumor was required in a second patient, but all six patients remain well and free of disease, with from three to six years follow-up to date. A further seven patients with advanced recurrent lesions were also treated using "basal" chemotherapy as the initial treatment. In three of these the carcinoma remained uncontrolled, but in four the tumor appears to have been controlled with subsequent follow-up radiotherapy being used in two cases, surgery in a third, and intermittent chemotherapy in the fourth. The numbers of patients treated in this series are insufficient to allow conclusions to be drawn concerning present management methods. However, the trend of the results to date suggests that for advanced lesions, improved survival may well result from the combination of basal chemotherapy with subsequent radiotherapy and/or surgery.

mentioning

confidence: 99%

Treatment of advanced cancer of the lower lip—the use of intraarterial or intravenous chemotherapy as basal treatment

Hambly

1981

Cancer

“…Advantage has been taken of present-day information that with appropriate combinations of agents used for a relatively short, intense course of treatment prior to surgery or radiotherapy, tumours may be reduced in size and viability. This may then allow extirpative surgery or curative radiotherapy to be applied with greater prospect of a successful outcome (Helman and Bennett, 1968;Jussawalla and Shetty, 1978;Richard. et alii, 1975;Stephens, 1978).…”

Section: Discussionmentioning

confidence: 99%

“…CONCLUSIONS From the several reports now available from rather scattered individual centres, it seems clear that the use of appropriate combinations of chemotherapeutic agents infused into a suitable regional artery of supply can be most effective as basal treatment. A previously incurable lesion may thus be reduced to proportions and reduced in viability to such an extent that management with follow-up radiotherapy and/or surgery can have some prospect of tumour eradication (Jussawalla and Shetty, 1978;Koyama et a h , 1975;Sealy and Helman, 1972;Stephens, 1978). the numbers of patients appropriate to meet these criteria in any one centre are inevitably quite limited.…”

Section: Discussionmentioning

confidence: 99%

The Intraarterial Infusion of Chemotherapeutic Agents as “Basal” Treatment of Cancer: Evidence of Increased Drug Activity in Regionally Infused Tissues

Australian and New Zealand Journal of Surgery

Crea

1980

There is evidence from a number of centres that some forms of locally advanced and aggressive cancers which are difficult to eradicate by standard means can be reduced by the use 01 “basal” chemotherapy to a degree which will allow more certain tumour eradication by subsequent radiotherapy and/or surgery. Clinicians have been divided as to whether there is an advantage in giving the chemotherapeutic agents directly into a regional artery of supply where this is feasible, as opposed to their systemic administration. This paper documents supportive evidence that some and possibly many chemotherapeutic agents are more effective if given regionally into an artery of supply. There is a higher incidence of local side‐effects in the region infused, including loss of hair, inflammatory changes, and ulceration of the skin or mucosa of the region infused. After intraarterial infusion of tagged bleomycin (indium‐Ill bleomycin) into a limb, the radioactive isotope remained more concentrated in the limb infused than in the opposite limb for at least 24 hours. Systemic side‐effects, including bone‐marrow depression, are less frequent and less severe in patients given chemotherapeutic agents by intraarterial infusion than if the same doses of agents are given intravenously. There is now sufficient evidence of the value of basal chemotherapy used in this way to make it mandatory that medical oncologists and surgeons, working together, should plan controlled studies to determine the most appropriate applications of this technique of management.

“…Appropriate combinations of effective agents are more likely to be successful than single agent therapy. The most widely used application of this technique has still been in the head and neck region, where advanced lesions normally considered incurable have often been reduced to proportions where they are controllable by follow-up radiotherapy or surgery or both (Burkhardt and Holtje, 1975;Curioni and Quadu, 1978;Donegan, 1975;Freckman, 1975, Jussawalla andShetty, 1978;Lundberg, 1977;Stephens, 1974). This use has been termed "basal" chemotherapy (Stephens, 1978).…”

mentioning

confidence: 99%

Intraarterial Infusion Chemotherapy in Salvage of Limbs Involved With Advanced Neoplasms

Crea

Australian and New Zealand Journal of Surgery

et al. 1980

Partial or complete limb salvage has been achieved in seven patients by the use of basal intraarterial infusion chemotherapy. All had either refused amputation or had been considered unsuitable for it. Results in all cases showed marked tumour regression to a size where local measures were then successful in controlling the disease. Six of the patlents are alive and well with no sign of recurrence at periods ranging from four months to six years.