Monocomponent chemoembolization in oral and oropharyngeal cancer using an aqueous crystal suspension of cisplatin

Abstract

Intensification of intra-arterial chemotherapy with high-dose cisplatin and concomitant reduction of toxicity under the conditions of the head and neck was aimed at by combination of antineoplastic activity and embolizing effect in the same pharmacon. A cisplatin suspension in normal saline (5 mg in 1 ml) with precipitation of microembolizing cisplatin crystals was prepared. No additional pharmacons. Cisplatin dosage was 150 mg m 72 , maximum absolute dose 300 mg, maximum amount of fluid 60 ml. Thirty patients (UICC-Classification of tumours: I/2 patients, II/6, III/2; IV/20) were treated in a neoadjuvant setting with superselective chemoembolization using the cisplatin suspension. A control group (n=30) with the same tumour and nodal staging was treated with a usual cisplatin solution (150 mg m 72 dissolved in 500 ml saline). In both groups, parallel intravenous infusion of sodium thiosulphate (9 g m 72 ). Endpoints were toxicity and response. Continuation of treatment by surgery or radiation. Overall remission was 70% in the study group and 46.7% in the control group after one cycle respectively. Systemic side-effects were very low (grade I WHO) in both groups. Side-effects were found to be similar to post-embolization syndrome (swelling, mild to moderate pain, leucocytosis without fever) in the study group. Chemoembolization in the head and neck area can be carried out routinely using this method.

Multimodality Treatment Including Postoperative Radiation and Concurrent Chemotherapy with Weekly Docetaxel is Feasible and Effective in Patients with Oral and Oropharyngeal Cancer

“…Therefore we considered a combination of several locally active treatment modalities a reasonable and promising approach. Published data suggest that intra-arterial high-dose chemotherapy is associated with a very low incidence of acute systemic side effects [22][23][24]; this is particularly important for the treatment of patients with a high comorbidity. Our results confirm that high-dose intra-arterial cisplatin is feasible, well tolerated and highly effective.…”

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

“…After chemoperfusion was completed, no more sodium thiosulphate was given. Starting in May 2000, tumour sites in the floor of mouth and the mobile tongue have been treated with an aqueous crystal suspension of cisplatin (5 mg in 1 ml); the absolute dose of cisplatin has been the same (Kovács et al, 2002). After the treatment, 1 l of full electrolyte solution containing 20 mval potassium chloride was infused again i.v.…”

“…By far, the largest population (213 patients) in this group was reported by Kovács et al (1999) and Kovács (2003a); the other investigators having reported between 13 and 23 patients. Performing a modification of the method adopted by Robbins et al (1994Robbins et al ( , 2000b for the head and neck (IA high-dose cisplatin plus systemic antagonisation with sodium thiosulphate), Kovács and co-workers could clinically and pharmacologically demonstrate a very low rate of acute side effects in the neoadjuvant setting (Kovács et al, 2002;Kovács, 2003a, b;Tegeder et al, 2003). In the period between 1996 and today (September 2003), over 350 patients with primary and recurrent malignancies of the head and neck have been treated with IA high-dose cisplatin in the author's institution.…”

Chemoembolization Using Cisplatin Crystals as Neoadjuvant Treatment of Oral Cancer

“…This new dosage format of cisplatin (crystal suspension) combined both antineoplastic and embolizing effects in one agent. 15 For preparation of the infusion of a cisplatin solution, the manufacturer recommends diluting the cisplatin dose to a maximal concentration of 1 mg/ml. 20 At concentrations higher than 1 mg/mL, a precipitation of cisplatin occurs (suspension).…”

“…[12][13][14][15] The clinical results of this novel development led to a regular usage of chemoembolization in 103 patients with cancer of the head and neck, and are presented in this paper. Therefore, experience with local chemotherapy is based on the treatment of over 380 patients to date.…”