International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationThermochemoradiation Therapy Using Superselective Intra-arterial Infusion via Superficial Temporal and Occipital Arteries for Oral Cancer With N3 Cervical Lymph Node Metastases
Introduction
Patients with head-and-neck squamous cell carcinoma with advanced cervical metastases present a treatment dilemma because their prognosis is generally considered poor. When cervical lymph node metastases exceed 6 cm in the largest diameter (N3), treatment of these metastases is extremely difficult and often results in poor prognoses (1). The use of hyperthermia (HT) has generally been confined to treatment of cervical lymph node metastases, accessible with a radiofrequency system using external application, and in combination with synergistic chemoradiation therapy (CRT). HT is appealing because it is a physical treatment with fewer side effects than chemotherapy or radiation therapy. Repeated HT treatments should be feasible without concern for cumulative toxic side effects. Preoperative thermochemoradiation therapy has been shown to reduce N3 cervical lymph node metastases to surgically treatable sizes and to result in high clinical and pathological responses and improved survival rates (2).
A method of superselective intra-arterial infusion via a superficial temporal artery (STA) was developed 3, 4. This treatment can be used to provide daily concurrent radiation therapy and chemotherapy for patients with advanced head-and-neck cancer. This method has been used in the clinical setting since 1996 for organ preservation and improvement of treatment of patients with advanced head and neck cancer 3, 5; however, this method showed insufficient effects on cervical lymph node metastases, especially N2 and N3 disease. There have been a few clinical trials of patients with head-and-neck squamous cell carcinoma with N3 cervical lymph node metastases who were treated with thermoradiation therapy plus systemic chemotherapy, but no trials using thermoradiation therapy plus superselective intra-arterial chemotherapy have been reported. The present study evaluated the therapeutic results and histopathological effects of thermochemoradiation therapy using superselective intra-arterial infusion via STA and an occipital artery (OA) in patients with N3 cervical lymph node metastases of advanced oral cancer.
Section snippets
Patients
Between April 2005 and September 2010, 9 patients with stage T2-T4 N3 squamous cell carcinoma of the oral cavity and no evidence of distant metastasis when initially evaluated underwent intra-arterial CRT combined with HT at the Department of Oral and Maxillofacial Surgery of the Nagoya Graduate School of Medicine, Nagoya, and the Yokohama City Graduate School of Medicine, Yokohama, Japan (Table 1). Patients were required to have an Eastern Cooperative Oncology Group performance status (//ecog.dfci.harvard.edu/general/perf_stat.html
HT treatment
The median number of HT treatments was 4 (range, 2-8 sessions), the median maximum temperature in the central surface of the N3 disease was 43.4°C (range, 43.1°C-44.0°C), and the median minimum temperature was 42.2°C (range, 39.6°C-43.0°C) (Table 1).
Treatment results and pathological responses
Pathological responses and outcomes are shown in Table 2. For all patients, the median follow-up was 37 months (range, 7-70 months). Therapy as described above was completed in all patients. No major complications, such as cerebral infarctions or
Discussion
Superselective intra-arterial chemotherapy for head and neck cancer has the advantage of delivering a high concentration of chemotherapeutic agents to the tumor bed, and it is divided into 2 types: one type is selective arterial infusion through the femoral artery by Seldinger's method 9, 10; and the other type is retrograde selective infusion via STA and OA 3, 4, 5, 7. Of note, retrograde superselective intra-arterial infusion has become feasible for daily concurrent radiation therapy and
Conclusions
In conclusion, the present study has demonstrated that thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and LRC rates for patients with advanced oral cancer with N3 cervical lymph node metastases. However, patients with N3 metastatic lymph nodes had a high rate of distant failure. Adjuvant chemotherapy after definitive treatment is recommended to reduce the risk of distant metastases for all patients with N3 disease.
Acknowledgment
The authors thank Dr Masaharu Hata and Dr Suomi Kurihara, Department of Radiology, for performing the radiation therapy and hyperthermia treatments.
References (20)
- et al.
New superselective intra-arterial infusion via superficial temporal artery for cancer of the tongue and tumour tissue platinum concentration after carboplatin (CBDCA) infusion
Oral Oncol
(1998) - et al.
A new method of selective intra-arterial infusion therapy via the superficial temporal artery for head and neck cancer
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2008) - et al.
Organ preservation with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via a superficial temporal artery for T3 and T4 head and neck cancer
Int J Radiat Oncol Biol Phys
(2011) - et al.
Use of the concept of equivalent biologically effective dose (BED) to quantify the contribution of hyperthermia to local tumor control in radiohyperthermia cervical cancer trials, and comparison with radiochemotherapy results
Int J Radiat Oncol Biol Phys
(2009) - et al.
Treatment results on advanced neck metastasis (N3) from head and neck squamous carcinoma
Otolaryngol Head Neck Surg
(2005) - et al.
Outcome with neck dissection after chemoradiation for N3 head-and-neck squamous cell carcinoma
Int J Radiat Oncol Biol Phys
(2010) - et al.
Efficacy of adjuvant chemotherapy for patients with resectable head and neck cancer: a subset analysis of the head and neck contracts program
J Clin Oncol
(1990) - et al.
Prognostic evaluation of preoperative thermochemoradiotherapy for N3 cervical lymph node metastases of oral cancer
Oncology
(2002) - et al.
Catheter placement via the occipital artery to achieve superselective intra-arterial chemotherapy for oral cancer
Jpn J Head Neck Cancer
(2008)
Cited by (16)
Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: Analysis of therapeutic results in 112 cases
2014, Radiotherapy and OncologyCitation Excerpt :This method has been performed since 1996 for organ preservation and improvement of treatment results in patients with advanced head and neck cancer [7]. For patients with N2 and N3 cervical lymph node metastases, retrograde superselective intra-arterial CRT combined with hyperthermia was utilized [9]. In cases of locally advanced tongue carcinoma (T3 and T4), the primary tumor extends to the floor of the mouth, lower gingiva and/or extrinsic muscle of the tongue.
Diameters of lingual, facial, and maxillary arteries measured according to an objective protocol on 3D computed tomography angiography images
2024, International Journal of Computer Assisted Radiology and SurgeryPotentiation of Anticancer Activity of G<inf>2</inf>/M Blockers by Mild Hyperthermia
2023, Anticancer ResearchN3 (> 6 cm) squamous cell carcinoma of the head and neck: Outcomes and predictive factors in 104 patients
2021, Acta Otorhinolaryngologica Italica
Conflicts of interest: none.