Rapid superselective high‐dose cisplatin infusion for advanced head and neck malignancies

Abstract

Advances in vascular radiology techniques for superselective arterial infusions and methods to overcome systemic toxicity from high-dose cisplatin chemotherapy encouraged us to reevaluate the effects of rapid regional cisplatin infusion for patients with head and neck malignancies. Twenty patients (17 carcinomas, three sarcomas) received high-dose cisplatin (100-200 mg/m2) by this method. Fifteen of the 17 patients with upper aerodigestive tract carcinoma are part of an ongoing phase I dose escalation of cisplatin with sodium thiosulfate neutralization. Three additional patients with sarcomas were treated with intra-arterial (IA) cisplatin and systemic Adriamycin. Fifty-three IA infusions were performed without any complications. Only minimal toxicity related to the chemotherapy was observed. The overall response rate for previously untreated patients was nine of 10 (90%) [complete response (CR) 67%; partial response (PR) 33%]. The response rate for patients with recurrent disease was five of eight (63%) (CR 20%, PR 80%). The average length of follow-up is 9.5 months and the actuarial survival rate is 56%. Superselective rapid infusion of high-dose cisplatin for patients with advanced head and neck malignancies is feasible, relatively nontoxic, and may have important applications in multimodality therapy, particularly for patients with bulky primary disease.

Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis

“…Recently, superselective intra-arterial chemotherapy in combination with concomitant radiotherapy (RADPLAT) has been performed for patients with locally advanced HNSCC and has been reported to result in a favorable outcome, preserving function and improving survival [4,5]. We considered RADPLAT to be applicable to the treatment of RPLN metastasis and, therefore, assessed the efficacy and feasibility of this non-surgical treatment for HNSCC patients with RPLN metastasis.…”

“…However, therapeutic RPLN dissection is technically challenging because of the limited surgical field and adhesion of the RPLNs to the surrounding tissue [14]. Even if surgery can be undertaken, the surgical procedure can result in severe post-operative complications, including bleeding and swallowing dysfunction due to lower cranial neuropathy.Recently, there have been several reports on the effectiveness of RADPLAT for local advanced HNSCC [4][5][6]17,18], although a multicenter, randomized phase 3 trial comparing RADPLAT and intravenous chemoradiation did not show the superiority of RADPLAT to intravenous chemoradiation for locally advanced HNSCC [19,20]. We consider that RADPLAT can be applied to the treatment of RPLN metastases by injecting cisplatin to the vessels feeding RPLN metastases, but none has ever reported the efficacy and feasibility of this 8 procedure.…”

Impact of Superselective Transarterial Infusion Therapy of High-Dose Cisplatin on Maxillary Cancer with Orbital Invasion

“…The 5-year survival rates in patients with T4 receiving trimodal therapy have been found to be approximately 50%. 2,3 Superselective transarterial infusion therapy using highdose cisplatin was introduced as a novel intra-arterial infusion chemoradiotherapy regimen (radiotherapy and concomitant intra-arterial cisplatin) by Robbins et al [4][5][6] We began using this treatment in our patients with maxillary cancer in 1998. Since that time, both the local control rate and the disease-free survival rate have improved markedly; moreover, no patient has undergone eyeball removal, even patients with orbital invasion.…”

Antitumor effects on primary tumor and metastatic lymph nodes by superselective intra-arterial concurrent chemoradiotherapy for oral cancer

“…Recently, superselective intra-arterial infusion and chemoradiotherapy has been introduced as new strategy for oral cancer. Robbins et al 7,8 inserted a catheter into the target artery by the Seldinger method via the femoral artery, and administered high-dose cisplatin (CDDP) with the result of a high percentage of local control for oral cancer. Another method of superselective intra-arterial infusion and chemoradiotherapy was introduced by Tohnai et al 9 .…”