Abstract
BackgroundChemoradiotherapy has a dominant role in therapy for head and neck cancers. However, impressive results are often disturbed by adverse events such as dysphagia, xerostomia, and functional speech and hearing loss. To avoid exceeding toxicity limits in patients with primary and recurrent cancers of the tonsils, chemotherapy was administered intra-arterially via implantable Jet-Port-Allround catheters.MethodsWe report on patients with primary and recurrent cancers of the tonsils. Eleven patients who refused chemoradiation were included in this trial. Of the seven patients without prior therapy, one was stage I, one was stage III, three were stage IVA, one was stage IVB, and one was stage IVC. The four patients who were in progression after prior chemoradiation were stage IVA. The median follow-up time was 47 months (20 to 125 months).After the implantation of a Jet-Port-Allround catheter into the carotid artery, the patients received intra-arterial infusion chemotherapy with venous chemofiltration for systemic detoxification. The stage I patient received lower-dose chemotherapy without chemofiltration. The stage IVC patient with lung metastases and a primary tumor that extended across the midline to the contralateral tonsil received additional isolated thoracic perfusion chemotherapy.ResultsAll seven chemoradiation-naïve patients exhibited clinically complete responses and are still alive after 20 to 125 months. Among the four patients who had relapsed after prior chemoradiation, the intra-arterial therapy elicited only poor responses, and the median survival time was 7.5 months. After carotid artery infusion chemotherapy, none of the patients required tube feeding. No cases of dysphagia, xerostomia, or functional speech and hearing loss have been reported among the patients without prior chemoradiotherapy.ConclusionDespite the administration of low total dosages, intra-arterial infusion generates high concentrations of chemotherapeutics. In combination with chemofiltration, the systemic toxicity is kept within acceptable limits. Among the non-pretreated patients, better tumor responses and long-term tumor control were noted compared with those who had prior chemoradiation. Implantable Jet-Port-Allround carotid artery catheters facilitate the application of regional chemotherapy.
Highlights
Chemoradiotherapy has a dominant role in therapy for head and neck cancers
Local tumor control and survival rates for all stages of head and neck cancers have been improved by the application of high-dose chemoradiation as a standard therapy
Complete responses in the chemoradiation naïve patients were reached upon the administration of the following regimens: (i) Intra-arterial chemotherapy (IAC) without chemofiltration (6 cycles, one patient, stage I, still alive at 125 months), (ii) IAC with chemofiltration (4–7 cycles, five patients, stages III to IVB, all still alive at 20–57 months), and (iii) isolated thoracic perfusion and IAC with chemofiltration (1 and 3 cycles, respectively, one patient, stage IVC, still alive at 89 months)
Summary
Impressive results are often disturbed by adverse events such as dysphagia, xerostomia, and functional speech and hearing loss. To avoid exceeding toxicity limits in patients with primary and recurrent cancers of the tonsils, chemotherapy was administered intra-arterially via implantable Jet-Port-Allround catheters. Local tumor control and survival rates for all stages of head and neck cancers have been improved by the application of high-dose chemoradiation as a standard therapy. The quality of life for patients who undergo chemoradiation is substantially jeopardized due to increased toxicity, which can cause conditions such as dysphagia, mucositis, xerostomia, weight loss, functional speech and hearing loss and the need for a tracheostomy and feeding tube. To avoid exceeding acceptable toxicity levels in patients with primary and recurrent cancers of the tonsils, chemotherapy was administered intra-arterially via implantable Jet-Port-Allround catheters
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