High-dose superselective intra-arterial cisplatin and concomitant radiation (radplat) for advanced head and neck cancer

• Published in: Head & neck 2004-06, Vol.26 (6), p.485-493
• Main Authors: Balm, Alfons J. M., Rasch, Coen R. N., Schornagel, Jan H., Hilgers, Frans J. M., Keus, Ronald B., Schultze-Kool, Leo, Ackerstaff, Annemieke H., Busschers, Wim, Tan, I. Bing
• Format: Article
• Language: English
• Subjects: Adult; advanced head and neck cancer; Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Biological and medical sciences; chemoradiation; Cisplatin - administration & dosage; Cisplatin - adverse effects; Dose-Response Relationship, Drug; Female; Gastrointestinal Diseases - chemically induced; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Hearing Loss - chemically induced; Heart Failure - chemically induced; Hematologic Diseases - chemically induced; Humans; Infusions, Intra-Arterial; Ischemic Attack, Transient - chemically induced; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Mouth Mucosa - drug effects; Nausea - chemically induced; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Radiotherapy, Adjuvant - adverse effects; Skin Diseases - chemically induced; Treatment Outcome; Tumors
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.20006

Background. The purpose of this study was to study the effect of intensive targeted chemoradiation in a group of patients with head and neck cancer with stage IV inoperable disease. Methods. We examined 79 patients with inoperable stage IV head and neck cancer receiving intra‐arterial infusion of high‐dose cisplatin (150 mg/m2) on days 2, 9, 16, and 23 concomitant with delivery of external beam radiotherapy (total dose, 70 Gy; 2 Gy, 35 fractions; 1 fraction/day for 7 weeks). Sodium thiosulfate was administered intravenously to provide effective cisplatin neutralization. Results. Four patients were not assessable. Complete local tumor response was achieved in 72 patients (91%) and a partial response in three patients. The complete response rate of neck node metastases was 90%. The 1‐ and 2‐year locoregional control rates were 82% and 69%, respectively. The median overall survival time was 2.2 years, with a 3‐year overall survival probability of 43%. Acute toxicities were as follows: grade III/IV hematologic toxicity (22%/16%), grade III/IV nephrotoxicity (0%), grade III mucositis (43%), grade III skin reactions (24%), grade III toxicity of the upper gastrointestinal tract (57%), grade III nausea (20%), and grade III subjective hearing loss (10%). Grade V toxicity (treatment‐related deaths) was 3.8%. Six (18%) of 33 patients with complete remission needed tube feeding 2 years after treatment without intercurrent salvage surgery. Conclusions. Supradose superselective intra‐arterial cisplatin and concomitant radiation is an effective organ‐preserving therapy in an unfavorable group of patients. Our series confirms encouraging results reported previously. This regimen is justified in unresectable patients despite the substantial toxicity. © 2004 Wiley Periodicals, Inc. Head Neck 26: 485–493, 2004