Impact of intra-arterial chemotherapy including internal carotid artery for advanced paranasal sinus cancers involving the skull base

Abstract

Background:The most significant problem of intra-arterial chemotherapy for advanced paranasal sinus carcinomas and residual cancers supplied by internal carotid artery (ICA) and involving the skull base is the lack of salvage therapies.Objective:The objective of the study was to evaluate the usefulness of intra-arterial chemotherapy including ICA infusion for treating advanced paranasal sinus carcinomas, which have invaded the skull base.Methods:Forty-six patients with advanced paranasal sinus carcinomas supplied by ICA were treated by intra-arterial chemotherapy using CDDP and sodium thiosulphate (STS) as a neutraliser of CDDP toxicity. After evaluating CT angiography, 150 mg m−2 of CDDP was superselectively administered weekly to each feeding artery including ICA four times.Results:The 10-year overall survival rate and progression-free survival rate were 70.7 and 60.2%, respectively. Compared with control group without infusing ICA, recurrences at anterior skullbase or anterior ethomoid sinus were significantly diminished. Of 32 patients in which the orbital apex had been invaded, 29 patients were treated with successful preservation of orbital contents. The CT angiography could efficiently determine all feeding arteries supplying the cancers. Consequently, chemotherapy could be administered on schedule, and side effects were minimal and acceptable.Conclusions:This new method has promising applications in the treatment of advanced paranasal sinus carcinomas involving the skull base.

Invasion of pterygoid plates; an indicator for regional lymph node failure in maxillary sinus cancer

“…Our results were similar to those of other studies [5,6]. The combination of IA chemotherapy and external radiation therapy or proton therapy can improve LC and OS [7,13]. Homma et al reported good results for 5-year LC (66%) and 5-year OS for stage cT4a (67%) and cT4b (57%) after external radiotherapy and IA chemotherapy [6].…”

“…We previously reported the treatment results of the combination of superselective IA chemotherapy and radiation therapy, and the total dose of 60 Gy was effective and safe in that setting. Therefore, we treated the patients in this report using the same radiation dose [7]. Previous studies reported high frequencies of the high-grade late adverse event of optic neuropathy (35%) when combining irradiation therapy with IA chemotherapy.…”

Invasion of Pterygoid Plates; an Indicator for Regional Lymph Node Failure in Maxillary Sinus Cancer

“…Our results were similar to results in other studies [5,6]. The combination of IA chemotherapy and external radiation therapy or proton therapy can improve LC and OS [7,13]. Homma et al reported good results for 5-year LC (66%) and 5-year OS for stage cT4a (67%) and cT4b (57%) after external radiotherapy and IA chemotherapy [6].…”

“…The combination of radiation therapy and intraarterial (IA) chemotherapy is a promising treatment for unresectable or surgery-refused MSC because of its high local control rate and overall survival [5,6]. This is a popular treatment in Japan, and although it is not a standard method, we have treated patients with locally advanced MSC using this combination, and reported good results [7]. In this setting, we have performed ENI only for patients with regional lymph node metastasis (cN+).…”

Comment on ‘Impact of intra-arterial chemotherapy including internal carotid artery for advanced paranasal sinus cancers involving the skull base’

“…We read with great interest the paper by Yokoyama J et al , 2014 . ‘Impact of intra-arterial chemotherapy including internal carotid artery for advanced paranasal sinus cancers involving the skull base'.…”