Intra-arterial chemoradiotherapy for head and neck cancer

Abstract

Intra-arterial chemotherapy has been used to treat localized malignant neoplasms in patients with head and neck cancer for over 50 years as the head and neck region is particularly well suited to regional chemotherapy. Early intra-arterial chemotherapy did not prove its efficacy. In addition, the additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. Subsequent significant advances in vascular radiology techniques and the development of new devices, such as fluoroscopy units and angiographic catheters, have made possible safe, accurate and repeated superselective intra-arterial chemotherapy. Intra-arterial infusion of high-dose cisplatin with systemic neutralization by intravenous sodium thiosulfate (RADPLAT) is a theoretically attractive approach to the treatment of advanced head and neck cancer. However, a Dutch trial comparing intra-arterial and intravenous chemoradiotherapy for advanced head and neck cancer showed that RADPLAT was not superior to intravenous chemoradiotherapy. Therefore, further investigation of RADPLAT, including the refinement of the indications for its application, is needed.

Percutaneous Image-Guided Cryoablation of Head and Neck Tumors for Local Control, Preservation of Functional Status, and Pain Relief

“…Due to these complication rates, there has been much recent active research into alternative, less invasive, new potential treatment options for recurrent and metastatic head and neck cancer including superselective intra-arterial chemotherapy infusion (2–4) as well as re-irradiation with protons (5,6), carbon ions (6), charged particle beams (7), and stereotactic body radiotherapy (8). Superselective intra-arterial chemotherapy has not demonstrated superiority to standard intravenous chemotherapy (4) while long-term follow-up will be needed for the radiation studies to evaluate associated late toxicities, which lead to speech and swallowing impairment in 43% of patients receiving traditional radiation therapy (9).…”

Computational fluid dynamics study of intra-arterial chemotherapy for oral cancer

“…However, radical surgery for advanced oral cancer often causes severe oral dysfunction—such as disorders of speech, mastication, and swallowing—and results in lower quality of life. To preserve organ function, a multidisciplinary approach that combines radiotherapy and chemotherapy has become a viable alternative to radical surgery in advanced cases [1, 2]. …”

“…Intra-arterial chemotherapy (IAC) has been used to treat head and neck cancer since the 1950s [1]. In this method, a linear catheter is placed near a target tumor-feeding artery originating from the external carotid artery (ECA; Fig.…”

“…Intratumoral concentrations of anticancer agents therefore fluctuate, and the efficacy of early IAC was unproven [1, 3]. Recently, progress in vascular radiological techniques has led to the development of superselective IAC (SSIAC), which has the advantage of delivering a higher concentration of anticancer agent to the tumor bed than conventional IAC, and has been applied to head and neck cancer, including oral cancer [1–3]. SSIAC may be delivered via the superficial temporal artery (STA) or femoral artery (Fig.…”

“…SSIAC may be delivered via the superficial temporal artery (STA) or femoral artery (Fig. 1b, c) [1, 3], and a catheter is inserted into a tumor-feeding artery originating from the ECA, such as the lingual artery (LA), facial artery (FA), or maxillary artery (MA). In SSAIC via the femoral artery (Seldinger’s method), the catheter is inserted into a branch of the ECA in an antegrade fashion by interventional radiologists (Fig.…”