American Journal of Neuroradiology 22:S16-S17, September- 2001
© 2001 American Society of Neuroradiology
Articles
Head and Neck Chemotherapy
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Introduction
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Intra-arterial chemotherapy for cancer of the head and neck
is a well-established but evolving technique for the treatment
of advanced tumors in that region. It is intended for patients
for whom traditional therapy has failed. As the procedure evolves,
it may gain wider application. It is a method that requires
a team approach. The basic members of the team are a neuroendovascular
physician and an oncologist. Additional members of the team
ideally include a head and neck surgeon and a radiation oncologist.
Current techniques involve selective catheterizations of the
branches of the ECA. Approaches in the literature include both
a traditional femoral approach and a surgical approach for long-term
treatment with a cut-down on the superficial temporal artery
and implantation of a pump.
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Indications
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The procedure shall be deemed appropriate and indicated in the
following situations: 1) standard therapy regimens have failed,
and the intra-arterial chemotherapy is being performed as in
an effort to control tumor growth; 2) intra-arterial chemotherapy
is being performed as a standard part of a treatment regimen,
as determined by the patient's treating physicians; and 3) the
patient is enrolled in an institutional review board-approved
study of intra-arterial chemotherapy as an alternative or adjunct
to standard treatment of the tumor.
Threshold:
When intra-arterial chemotherapy is performed for other indications, a review should be prompted.
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Efficacy
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The response to treatment varies with the initial grade and
type of tumor. Initial response rates have been reported to
be as high as 100%. Complete response is unusual. Efficacy of
the therapy should be judged in comparison with standard treatment
as it evolves over time.
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Safety
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The historical data indicate a high rate of safety for the procedure.
Complications should be categorized into three groups: those
associated with angiography, with systemic toxicity, and with
local toxicity.
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Complications Associated with Angiography
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The potential complications associated with and thresholds for
neuroangiography are outlined elsewhere. Unique complications
associated with long-term catheterization using the slow infusion
method include thrombophlebitis and catheter infection. Thresholds
for these latter complications are outside the scope of this
document.
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Systemic Toxicity
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Systemic toxicity of the chemotherapy agent can be rated according
to the standard criteria outlined by the Eastern Cooperative
Oncology Group. Systemic toxicity should not exceed that of
IV therapy with the same agent.
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Local Toxicity
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Local toxicity includes hemicranial alopecia, mucositis, dermatitis,
skin necrosis, and peripheral and cranial nerve palsies (see
table below).
Threshold:
If thresholds for complications or toxicity are exceeded, a review should be conducted.
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Bibliography
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Lee YY, Wallace S, Dimery I, Goepfert H, Intraarterial chemotherapy of head and neck tumors. AJNR Am J Neuroradiol 1986;7:343-348[Abstract]
Moses BL, Chan DW, Hruban RH, Forastiere A, Richtsmeier WJ, Comparison of intra-arterial and intravenous infusion of cisplatin for head and neck squamous cell carcinoma in a modified rat model. Arch Otolaryngol Head Neck Surg 1993;119:612-617[Medline]
Los G, Blommaert FA, Barton R, Selective intra-arterial infusion of high-dose cisplatin in patients with advanced head and neck cancer results in high tumor platinum concentrations and cisplatin-DNA adduct formation. Cancer Chemother Pharmacol 1995;37:150-154[Medline]
Gore ME, Riches P, MacLennan K, Phase I study of intra-arterial interleukin-2 in squamous cell carcinoma of the head and neck. Br J Cancer 1992;66:405-407[Medline]
Robbins KT, Storniolo AM, Kerber C, Phase I study of highly selective supradose cisplatin infusions for advanced head and neck cancer. J Clin Oncol 1994;12:2113-2120[Abstract]
Cheung DK, Regan J, Savin M, Gibberman V, Woessner W, A pilot study of intraarterial chemotherapy with cisplatin in locally advanced head and neck cancers. Cancer 1988;61:903-908[Medline]
Baker SR, Wheeler RH, Forastiere AA, Medvec BN, Recent developments in the management of head and neck cancer with intra-arterial chemotherapy. In: Chretien OB, Johns ME, Shedd DP, Strong EW, Ward PH, eds Head and Neck Cancer vol 1: Philadelphia: B.C. Decker, Inc 1985;461
Oken MM, Creech RH, Tormey DC, Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655[Medline]
Shimizu T, Sakakura Y, Hattori T, Yamaguchi N, Kubo M, Sakakura K, Superselective intraarterial chemotherapy in combination with irradiation: preliminary report. Am J Otaryngol 1990;11:131-136
Robbins KT, Storniolo AM, Kerber C, Seagren S, Berson A, Howell SB, Rapid superselective high-dose cisplatin infusion for advanced head and neck malignancies. Head Neck 1992;14:364-371[Medline]
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Introduction
Indications