New Superselective Intra-Arterial Chemotherapy via Superficial Temporal Artery (HFT method) for Stage III, IV Oral Cancer

Abstract

Recently, combined radiotherapy and superselective intra-arterial chemotherapy using the Seldinger method was performed for head and neck cancers. However, intra-arterial chemotherapy and radiotherapy cannot be performed simultaneously every day, because long-term catheterization is not possible in Seldinger method. And the method has a problem such as cerebral infarction. Therefore, we developed a new method of superselective intra-arterial infusion via the superficial temporal artery (HFT method: Hattori, Fuwa and Tohnai reported) and preoperatively performed daily concurrent radiotherapy and chemotherapy with docetaxel (DOC) and cisplatin (CDDP) using this method for stage III, IV oral cancer. Forty-seven patients with stage III, IV oral cancer were treated. The new catheter was prepared by modifying an angiographic catheter measuring 1.35 mm in diameter. It was inserted superselectively to the feeding artery of the tumor via the superficial temporal artery using a guide wire. The long-term catheterization is possible in this method. Radiotherapy (total dose: 40 Gy) and superselective intra-arterial chemotherapy using DOC (total dose: 60 mg/m2) and CDDP (total dose: 100 mg/m2) were concurrently performed daily, followed by surgery. In 41 patients, intra-arterial infusion was successful, but 6 intra-arterial infusions were not successful because of arterial anomalies. The toxicities of over grade 3 were leukopenia of 7.3 %, thrombocytopenia of 2.9 %, mucositis of 22.0 %, and dermatitis of 12.2 %. No infection was observed in the catheterization. Then no major complication was observed. The clinical effects were CR in 34 (82.9 %) patients and PR in 7 (17.1 %), and pathological effects of resected tumor after surgery were pathological CR in 37 (90.2 %), and pathological PR in 4 (9.8 %). The 5-year cumulative survival rate (overall rate) was 78.8 %. This survival rate is higher than the rate of conventional therapy. This superselective intra-arterial infusion allows long-term catheterization unlike the Seldinger method, so that daily concurrent chemoradiotherapy can be performed. This method promises to be the new strategy of choice for the treatment of stage III, IV oral cancer.