Elsevier

Oral Oncology

Volume 38, Issue 2, February 2002, Pages 145-152
Oral Oncology

Continuous selective intraarterial chemotherapy in combination with irradiation for locally advanced cancer of the tongue and tongue base

https://doi.org/10.1016/S1368-8375(01)00035-5Get rights and content

Abstract

We retrospectively evaluated the results of the concurrent combination therapy of selective continuous intraarterial chemotherapy and radiotherapy in 39 patients with locally advanced cancer of the tongue and tongue base between September 1992 and January 2000. Thirty patients were fresh cases (stage II, 10 patients; stage III, 15; stage IV, five) and nine were recurrent cases. The primary lesion was present in the mobile tongue in 33 patients and the tongue base in six. External irradiation (median dose, 48.6 Gy) was performed in all patients, and interstitial brachytherapy using an Au grain or Cs needle (median dose, 50 Gy) in 21. In intraarterial chemotherapy, a catheter was selectively inserted into the lingual artery via the superficial temporal artery, and carboplatin (CBDCA) was continuously infused (median dose, 460 mg/m2) concurrently with radiotherapy. In 13 patients with cervical lymph node metastasis, two courses of systemic chemotherapy with 5-FU (700 mg/m2×5 days) and cisplatin (40–50 mg/m2×2 days) or its analog was also performed. In 37 (94.9%) of the 39 patients in whom this combination therapy was completed, the response rate was 94.6%. The 3-year local control rate, progression-free survival rate, and overall survival rate by Kaplan–Meier’s method were 79.2, 53.2, and 58.9%, respectively. This combination therapy was effective for locally advanced cancer of the tongue and tongue base without causing severe adverse side effects, and a local control rate comparable to that by surgery can be expected.

Introduction

During the past 20-year period, the treatment for locally advanced cancer of the tongue and tongue base has shown marked changes, such as advances in reconstructive surgery. However, the treatment results have only slightly improved. The standard treatment for locally advanced cancer of the tongue and tongue base is surgery, which is frequently extensive. Surgery has the greatest potential for cure. Therefore, many patients undergo extensive surgery, but they should compromise on postoperative marked dysfunction and a decrease in the quality of life.

Radiotherapy has long been used in this field, but the results of radiotherapy performed alone for locally advanced cancer have been poor. Therefore, radiotherapy is usually performed for a palliative intent or in combination with surgery. Another therapeutic option is intraarterial chemotherapy. This method has marked transient local effects, but its therapeutic power is inadequate in terms of control of advanced cancer. Each of the two therapeutic modalities has inadequate effects when performed alone.

However, treatment results can be improved by the effective combination of the two methods that allow preservation of the organ. To obtain maximum effects of each method, we took the following measures. (1) It is not the conventional non-selective intraarterial infusion, but the selective infusion that is performed, by inserting a catheter to the lingual artery. (2) The catheter is inserted for a long period for continuous drug infusion. (3) Radiotherapy is performed concurrently with intraarterial chemotherapy. We consider that this combination of intraarterial chemotherapy and radiotherapy has potential for improving treatment results with preservation of the organ.

At our hospital, the combination of selective continuous intraarterial chemotherapy and radiotherapy has been performed since August 1992 for preservation of the organ and improvement of treatment results in patients with locally advanced head and neck cancers who cannot undergo surgery for certain reasons. Between August 1992 and May 1997, phases I and II studies [1] on the combination of radiotherapy and selective continuous intraarterial chemotherapy with CBDCA was performed. As a result, the local control rate for cancer of the tongue and tongue base was significantly better than that for cancer in other head and neck cancers. This suggested that cancer of the tongue and tongue base among cancers in the head and neck region is an especially good indication for this combination therapy. In this study, patients with cancer of the tongue and tongue base were extracted from about 130 patients with advanced cancer in the head and neck cancers who underwent this combination therapy between September 1992 and January 2000, and its effects and results were evaluated.

Section snippets

Patients characteristics

The subjects were 39 patients with locally advanced cancer of the tongue and tongue base who underwent the combination of radiotherapy and continuous selective intraarterial chemotherapy at the department of radiation oncology, Aichi Cancer Center Hospital between September 1992 and January 2000 (Table 1). The primary lesion was located in the tongue in 33 patients and the tongue base in six. There were 30 males and nine females aged 36–86 years (median, 68 years). Thirty patients were fresh

Catheter performance and treatment completion rate

In nine of the 39 patients showing tumor invasion beyond the mid-line, catheters were bilaterally inserted. Thus, selective catheterization into the lingual artery was performed a total of 48 times in 39 patients, and catheterization could be successfully performed only by one operation in all cases.

The placement period of the 48 catheters was 18–96 days (median, 37 days), during which 12 catheters were dislocated from the lingual artery (dislocation rate, 25%). All dislocated catheters were

Discussion

The history of intraarterial chemotherapy for head and neck cancers is relatively long. Klopp et al. [10] was the first to report fractional intraarterial infusion of nitrogen mustard in 1950. After that, Sullivan et al. [11] reported continuous intraarterial infusion of methotrexate in 1959. Subsequently, various improvements have been made, and marked local effects of intraarterial chemotherapy mainly as adjunctive therapy for advanced and recurrent cancer have been reported [12], [13], [14],

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