High-dose, short-duration, intra-arterial cisplatin therapy for oral cancer.

Abstract

6038 Background: We developed a superselective intra-arterial chemotherapy (iaCT) approach for oral cancer wherein an intra-arterial catheter is retrogradely inserted via the superficial temporal artery (STA) and/or occipital artery (OA). In most iaCT cases, high-dose anticancer agents are administrated via the intra-arterial catheter weekly or biweekly with daily irradiation. This approach remarkably improves curative efficiency, but some adverse events, e.g., severe mucositis, dysphagia, dysgeusia, dry mouth, and radiation osteonecrosis, mainly because of irradiation, decrease the quality of life. Methods: Thirty-two patients with stage II, III, or IV oral squamous cell carcinoma were treated using this new iaCT approach. The catheter was superselectively placed in the tumor-feeding arteries by cut-down of STA or OA. The catheter was completely placed under the skin and was connected to an infusion reservoir that was subcutaneously implanted around the mastoid process via the subcutaneous tunnel, ensuring little possibility of catheter-related issues such as infection and displacement of catheter. Anticancer agents (30 mg/m2of cisplatin with/without 10 mg/m2of docetaxel) were intra-arterially administered via the reservoir twice a week for 3 weeks, 180 mg/m2/6 times in total, without irradiation. The treatment effect was assessed using computed tomography, positron emission tomography, and biopsy. Results: The response rate of this approach was 100%, with 31 and 1 case having complete response (CR) and partial response (PR), respectively. Five patients with delayed regional lymph node metastasis or PR underwent salvage surgery; 28 patients (87.5%) had disease-free survival, while 2 (6.2%) died due to local recurrence and 2 due to distant metastasis. All patients developed CTCAE v4.0 Grade 2 oral mucositis in the flow area of the intended artery, most of which disappeared in half a year. No dry mouth, dysgeusia, and eating disorder were observed because the patients did not receive radiotherapy. No systemic adverse events such as hematologic toxicity and renal and/or hepatic injuries occurred. Conclusions: This method improved the adverse event of iaCT with radiotherapy, and the main advantage of superselective iaCT was not lost.