Induction chemotherapy by superselective intra-arterial high-dose carboplatin infusion for head and neck cancer

Abstract

To evaluate the feasibility, maximum dose of drug tolerated, technical problems, systemic and local toxicity, response rate, overall and disease-free survival, we studied superselective intra-arterial infusion of high-dose carboplatin as part of a multimodality treatment for head and neck cancer. Forty patients with untreated stage II-IV head and neck squamous cell carcinomas received induction chemotherapy with high-dose carboplatin (three cycles at 2-week intervals using 300-350 mg/m2 per cycle), delivered via superselective transfemoral angiography followed by radiotherapy or surgery plus radiotherapy. No technical complications occurred during or after the infusion. Systemic toxicity was minimal, and local toxicity was moderate. At the end of chemotherapy the overall complete and partial response rate was 90% (36/40) at the primary site and 64% (16/25) at the neck nodes. The median follow-up was 24.4 months (range 3-52). To date 21 patients are alive without disease, 2 are alive with disease, 13 have died of disease, and 4 have developed a metachronous lung tumor. There was a good correlation between the response to chemotherapy and disease-free survival. No statistically significant benefit in survival was observed with respect to other series of head and neck tumors treated with different protocols. However, discriminating between responding and nonresponding patients, this procedure can have a prognostic significance in planning integrated treatments for these types of tumors.

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

“…[3] However, they perfused the metastatic nodes selectively too and that response never has been controlled histopathologically.…”

“…Several centers used iaCHT in a neoadjuvant preoperative setting [3][4][5][6][7] to reduce tumor size and hopefully the risk of local recurrences. In each of these studies, the evaluation of remission concentrated on the local tumor.…”

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

“…Truly neoadjuvant usage (before definitive treatment by surgery or radiation), with an exclusive transfemoral approach and superselective perfusion, has been rare (Korogi et al, 1995;Hirai et al, 1999;Benazzo et al, 2000;Damascelli et al, 2003). 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.…”

Selective High-Dose Intra-Arterial Cisplatin as Palliative Treatment for Incurable Head and Neck Cancer

“…The studies performed by Robbins and co-workers gave new impulses to intra-arterial chemotherapy, as their results were very promising: in their experience intra-arterial chemotherapy with cisplatin coupled with radiotherapy allows long-term survival [24,25]. In analogy to these results most of the applied therapeutical procedures with intra-arterial chemotherapy combined with radiotherapy revealed an overall response rate of about 90% [26][27][28]. This therapy could be performed safely with a low complication rate compared to standard intravenous chemotherapy [11].…”