Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results

Abstract

Intra-arterial (IA) chemotherapy for curative treatment of head and neck cancer experienced a revival in the last decade. Mainly, it was used in concurrent combination with radiation in organ-preserving settings. The modern method of transfemoral approach for catheterisation, superselective perfusion of the tumour-feeding vessel, and high-dose (150 mg m À2 ) administration of cisplatin with parallel systemic neutralisation with sodium thiosulphate (9 g m À2 ) made preoperative usage feasible. The present paper presents the results of a pilot study on a population of 52 patients with resectable stage 1 -4 carcinomas of the oral cavity and the oropharynx, who were treated with one cycle of preoperative IA chemotherapy executed as mentioned above and radical surgery. There have been no interventional complications of IA chemotherapy, and acute side effects have been low. One tracheotomy had to be carried out due to swelling. The overall clinical local response has been 69%. There was no interference with surgery, which was carried out 3 -4 weeks later. Pathological complete remission was assessed in 25%. The mean observation time was 3 years. A 3-year overall and disease-free survival was 82 and 69%, respectively, and at 5 years 77 and 59%, respectively. Survival results were compared to a treatment-dependent prognosis index for the same population. As a conclusion, it can be stated that IA high-dose chemotherapy with cisplatin and systemic neutralisation in a neoadjuvant setting should be considered a feasible, safe, and effective treatment modality for resectable oral and oropharyngeal cancer. The low toxicity of this local chemotherapy recommends usage especially in stage 1 -2 patients. The potential of survival benefit as indicated by the comparison to the prognosis index should be controlled in a randomised study.

Curative and organ-preserving treatment with intra-arterial carboplatin induction followed by surgery and/or radiotherapy for advanced head and neck cancer: single-center five-year results

“…Our present data confirmed the evidence that regional chemotherapy by superselective transfemoral infusion of high doses of platinum compounds is feasible and that, with the cooperation of an experienced interventional radiologist, can be easily reproduced in a multi-institutional setting, with minimal procedural complications [9,11,14-16]. …”

“…A true neoadjuvant intra-arterial chemotherapy approach for head and neck cancer treatment is rare and the results of many trials are difficult to compare, owing to a number of methodological differences [16]. Limiting our comparison to the latest studies conducted with platinum compounds, our response rates at the end of induction chemotherapy (CR 35% and PR 43%) are similar to those observed by Kovacs [16] (CR 38% and PR 31%) and lower than those observed by Wilson et al [25] (CR 68% and PR 23%).…”

Intra-arterial chemoradiotherapy for locally advanced oral cavity cancer: analysis of therapeutic results in134 cases

“…Currently, surgery is the standard treatment (Poulsen et al, 1996). Several studies have reported arterial injection therapy for oral cavity cancer; however, the number of patients in such studies tended to be small, and its usefulness has not yet been clearly (Hirai et al, 1999;Damascelli et al, 2003;Kovacs, 2004). No randomised controlled trials have yet been performed to compare the effectiveness of surgery with chemoradiation, and the usefulness of chemoradiation therapy involving systemic chemotherapy thus remains to be clarified.…”

The effect of intraarterial high-dose cisplatin on lymph nodes in oral and oropharyngeal cancer

“…[10] Perfusion was strictly selective to the primary, and no lymph nodes were perfused additionally. Three to four weeks later, remission of the primary was graded as: CR = complete remission, i.e.…”