Superselective intra-arterial infusion of high-dose cisplatin combined with radiation therapy for head and neck carcinoma. Experience of Yamagata University Hospital

Local effectiveness and complication of superselective intra-arterial infusion of high-dose cisdiamminedichloroplatinum (CDDP) (SIC) combined with radiation therapy (RT) were investigated. Between 1998 and 2000, 18 head and neck carcinomas including 10 maxillary carcinomas (T3; 1, T4; 9), 3 oral cavity carcinomas (T2; 1, T4; 2), and 5 oropharyngeal carcinomas (T2; 2, T4; 3) were treated with SIC and RT with or without surgery. CDDP of 100-150 mg/body was administered weekly in principle for 2-9 weeks (mean: 4.9) with the simultaneous administration of sodium thiosulfate. Radiation doses ranged from 40 Gy to 70 Gy (mean: 56.8 Gy). Complete response was obtained in 7 of 10 maxillary carcinomas, 2 of 3 oral-cavity carcinomas, and 2 of 5 oropharyngeal carcinomas, respectively. When surgical intervention was performed if necessary, 2-year local control rates for maxillary carcinoma, and other carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 80% and 63% respectively. Two-year local control rates for T4 maxillary carcinoma, and other T4 carcinoma including oral-cavity carcinoma and oropharyngeal carcinoma were 78% and 40% respectively. Two-year overall survival rates for all cases, maxillary carcinoma, and oral-cavity/oropharyngeal carcinoma were 88%, 90% and 86% respectively. All local recurrences occurred within 6 months from the initiation of treatment. The systemic toxicity of weekly SIC was comparatively mild; however, a total CDDP dose of 1,000 mg or more and/or RT of 70 Gy induced complications of local soft tissue such as mucosal ulcer and fistula. SIC combined with RT is useful to improve the local control/survival rates and to avoid the aggressive surgery for locally advanced head and neck carcinoma. A high total dose of CDDP and/or RT of a comparatively high dose may be risk factors for local soft tissue complications. (author)