Present role and future prospect of superselective intra-arterial infusion chemotherapy for head and neck cancer

摘要

Patients with head and neck squamous cell cancers (HNSC) of stage III and IV have a poor outcome, often losing important functions such as swallowing and speech despite combined surgery and radiotherapy. Two-thirds of such patients die of local recurrence and disseminated metastasis in spite of salvage therapy. Conventional adjuvant chemotherapy is often difficult for HNSC patients, since many of them suffer from associated chronic oral, respiratory and gastrointestinal diseases due to tobacco and alcohol in addition to having poor nutritional and oral hygienic conditions. Ninety-seven patients with advanced head and neck cancers were treated by superselective intra-arterial chemotherapy using CDDP and sodium thiosulfate (STS) from 1995 to 2000. Once a week, 100-150 mg/m2 of CDDP were administered superselectively at 5 mg/min through each artery feeding the tumor. During the infusion of CDDP, STS at a dose of two hundred fold that of CDDP was injected through a catheter placed in the subclavian vein. The complete and partial response rates were 72% and 25%, respectively, with 100% preservation of the larynx and 90% preservation of the eyeball in all involved cases. We could suppress mucositis of normal tissue and chemotoxicities leading to conditions such as renal and hematological dysfunction. Though our method currently has disadvantages such as the risk of cerebral infarction, the fact that chemotherapy must always be done under fluoroscopy, and the occurrence of distant metastasis, there are good prospects for the future and we are now working toward solving the present problems.