Daily Concurrent Chemoradiotherapy Research Articles

Daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced squamous cell carcinoma of the mandibular gingiva

ObjectiveWe previously reported that daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced oral cancer provided good local control and overall survival rates. This study was performed to evaluate the therapeutic results of daily concurrent intra-arterial chemoradiotherapy for patients with locally advanced squamous cell carcinoma of the mandibular gingiva. MethodsSixteen patients with T3, 4 mandibular gingiva cancer who refused surgery underwent definitive intra-arterial chemoradiotherapy between August 2006 and July 2014. Treatment consisted of concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion (60 Gy, total dose; 60 mg/m2 for docetaxel and 150 mg/m2 for cisplatin). ResultsComplete response of the primary site was obtained in 14 patients (87.5%). Five-year local control and survival rates were 73.4%and 81.3%, respectively. Grade 3 or 4 toxicities including mucositis and neutropenia were seen in 13 patients (81.3%) and 6 patients (37.5%), respectively. Grade 3 osteoradionecrosis occurred as a late adverse event in 1 patient (6.3%). ConclusionsRetrograde daily concurrent intra-arterial chemoradiotherapy for locally advanced carcinoma of the mandibular gingiva provided good local control and overall survival rates. This method can become one of the therapeutic options for patients with locally advanced carcinoma of the mandibular gingiva.

Organ preservation with daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced tongue cancer: analysis of therapeutic results in 101 cases.

6032Background: Extended surgery for patients with locally advanced oral tongue squamous cell carcinoma markedly reduces the patient’s quality of life (QOL). To preserve function while improving lo...

Daily low-dose Cisplatin-based concurrent chemoradiotherapy for the treatment of cervical cancer in patients 70 years or older.

It has been established that concurrent chemoradiotherapy (CCRT) is efficacious for cervical cancer, but adherence is unsatisfactory among elderly patients. To improve adherence, we have developed and initiated a daily low-dose cisplatin-based CCRT regimen. Here, we retrospectively evaluated the use of CCRT, especially for elderly patients. The study included a total of 53 patients who were 70 years or older, had stage IB-IVA cervical cancer, and were initially treated with daily CCRT. The daily CCRT comprised pelvic external beam radiotherapy (2 Gy/d × 25) with daily low-dose cisplatin (8.0 mg/m(2) per day) and either low- or high-dose-rate intracavitary brachytherapy. The median age was 72 years (range, 70-85 years). The median follow-up duration was 32 months (range, 2-104 months). The 3-year overall survival rate was 79.0%. Daily cisplatin chemotherapy was successfully completed in 32 (60.4%) of the 53 patients. Grade 3 or 4 neutropenia was observed in 19 patients (36%). A late complication of grade 3 rectal hemorrhage occurred in 3 patients who received high-dose-rate brachytherapy. All primary tumors responded to daily CCRT; complete response was observed in 43 patients (91.5%) and partial response was observed in 4 patients (8.5%). Daily CCRT in patients 70 years and older had acceptable compliance and safety. Daily CCRT is suggested to be a good treatment option for elderly patients who have advanced cervical cancer and require concurrent cisplatin.

Organ preservation with daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for stage III, IV oral cancer: Analysis of therapeutic results in 112 cases.

6060 Background: Retrograde superselective intra-arterial chemotherapy for oral cancer has the advantage of delivering a high concentration of the chemotherapeutic agents to the tumor bed, it can be used to provide daily concurrent chemoradiotherapy for patients with advanced oral cancer. The purpose of this study was to evaluate the therapeutic results and rate of organ preservation in 112 patients of stage III or IV (M0) oral cancer treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy. Methods: Between August 2006 and July 2011, 112 patients with stage III or IV oral squamous cell carcinoma underwent intra-arterial chemoradiotherapy. Catheterization from the superficial temporal and occipital arteries was performed. And treatment consisted of superselective intra-arterial chemotherapy (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and daily concurrent radiotherapy (total 60 Gy) for 6 weeks. Results: The median follow-up for all patients was 46.2 months (range, 10–90 months). The median follow-up for living patients was 49.7 months (range, 36–90 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 98 (87.5%) of 112 cases. Thirty patients (26.8%) died. Using the Kaplan-Meier method, 3-year, and 5-year survival rates were 74.6% and 71.3%, respectively, while 3-year, and 5-year local control rates were both 79.3%. Grade 3 or 4 toxicities included mucositis in 92.0%, neutropenia in 30.4%, dermatitis in 28.6%, anemia in 26.8%, and thrombocytopenia in 7.1%. Grade 3 toxicities included dysphagia in 72.3%, nausea/vomiting in 21.4%, fever in 8.0%, and renal failure occurred in 0.9%, no patients died as a result of treatment toxicity. Conclusions: Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for Stage III, IV oral cancer provided good overall survival and local control rates, thus preserving organs and contributing to patients’ QOL.

Organ preservation with daily concurrent chemoradiotherapy using a new superselective intra-arterial infusion for stage III, IV tongue cancer.

5556 Background: Combined radiotherapy and intra-arterial chemotherapy, which delivers a very high concentration of anticancer agent to the tumor, is currently used to treat advanced head and neck cancer. However, chemotherapy and radiotherapy cannot be performed simultaneously on a daily basis under conventional methods because long-term catheterization is not possible. Therefore, we developed a new method using superselective intra-arterial infusions via the superficial temporal artery and the occipital artery, and used it to perform daily concurrent chemoradiotherapy for the treatment of advanced tongue cancer. Methods: Seventy-two patients with advanced tongue cancer underwent chemoradiotherapy using this superselctive intra-arterial infusion method. Catheters were inserted superselectively to the feeding arteries of the tumor via the superficial temporal artery and the occipital artery. Long-term catheterization is possible in this method. Daily concurrent combined therapy with radiotherapy (total dose: 60 Gy), superselective intra-arterial chemotherapy using DOC (total dose: 60 mg/m2) and CDDP (total dose: 150 mg/m2) was performed. The anticancer agent was injected in a bolus through the intra-arterial catheter simultaneously with radiotherapy. Results: No major complications were observed. Clinical efficacy was CR in 64 (88.9 %) patients and PR in 8 (11.1 %). With a median follow-up period of 31 months (range 6 to 72 months), the overall survive rate was 74.8 % and the local control rate was 93.7%. Conclusions: This superselective intra-arterial infusion allows for long-term catheterization, unlike the conventional method, so that chemotherapy can be performed simultaneously with radiotherapy on a daily basis. This treatment method promises to be the strategy of choice for the treatment of advanced tongue cancer.

P184. Organ preservation with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via a superficial temporal artery for T3 and T4 head and neck cancer

P184. Organ preservation with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via a superficial temporal artery for T3 and T4 head and neck cancer

Management considerations for the patient with tongue squamous cell carcinoma associated with Behçet's disease: A case report

Malignancies associated with Behçet's disease (BD) are rare, and surgery for patients with BD frequently results in postoperative complications such as wound dehiscence, postoperative infection, and exacerbation of BD itself. We present a rare case of left tongue carcinoma in a 70-year-old woman with BD. The pathological findings showed moderate-differentiated squamous cell carcinoma with atypical squamous cell infiltrative proliferation. Daily concurrent chemoradiotherapy with docetaxel and cisplatin using superselective intra-arterial infusion via superficial temporal artery and occipital artery was performed. Two indwelling catheters, one from the left occipital artery to the left lingual artery and the other from the left superficial temporal artery to the left facial artery, were inserted to carry out superselective intra-arterial infusion treatment. After completion of all treatments, a biopsy specimen of the primary lesion showed grade III, nonviable tumor cells, suggesting complete response. Superselective intra-arterial chemoradiotherapy was effective for treating the tongue carcinoma associated with BD, and avoided surgical treatment. This method could control the primary lesion and cervical lymph node metastasis clinically without severe side effects. The patient has been disease free for 18 months without the complication of treatment.

Organ Preservation With Daily Concurrent Chemoradiotherapy Using Superselective Intra-Arterial Infusion via a Superficial Temporal Artery for T3 and T4 Head and Neck Cancer

To evaluate the therapeutic results and rate of organ preservation in patients with advanced head and neck cancer treated with superselective intra-arterial chemotherapy via a superficial temporal artery and daily concurrent radiotherapy. Between April 2002 and March 2006, 30 patients with T3 or T4a squamous cell carcinoma of the head and neck underwent intra-arterial chemoradiotherapy. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m(2); cisplatin, total 150 mg/m(2)) and daily concurrent radiotherapy (total, 60 Gy) for 6 weeks. The median follow-up for all patients was 46.2 months (range, 10-90 months). The median follow-up for living patients was 49.7 months (range, 36-90 months). After intra-arterial chemoradiotherapy was administered, primary site complete response was achieved in 30 (100%) of 30 cases. Seven patients (23.3%) died. Using the Kaplan-Meier method, 1-year, 3-year, and 5-year survival rates were 96.7%, 83.1%, and 70.2%, respectively, while 1-year, 3-year, and 5-year local control rates were 83.3%, 79.7%, and 73.0%, respectively. Grade 3 or 4 mucositis occurred in 20 cases (66.7%). Grade 3 toxicities included dysphagia in 20 cases (66.7%), dermatitis in 6 cases (20%), nausea/vomiting in 2 cases (6.7%), and neutropenia and thrombocytopenia in 1 case (3.3%). No osteoradionecrosis of mandible and maxillary bones developed during follow-up. Intra-arterial chemoradiotherapy using a superficial temporal artery provided good overall survival and local control rates. This combination chemoradiotherapy approach can preserve organs and minimize functional disturbance, thus contributing to patients' quality of life.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for T3 and T4 head and neck cancer: Possibility of organ preservation in advanced head and neck cancer

e17020 Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL. No significant financial relationships to disclose.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion (HFT method) via superficial temporal artery for T3 and T4 head and neck cancer—Possibility of organ preservation in advanced head and neck cancer

17044 Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck ...

Daily concurrent chemoradiotherapy with docetaxel (D) and cisplatin (C) using new superselective intra-arterial infusion via the superficial temporal artery (HFT method) for stage III, IV head and neck cancer—Preservation of the primary lesion

15513 Background: We previously developed a new method of superselective intra-arterial infusion via the superficial temporal artery (HFT method; Hattori, Fuwa and Tohnai). Our previous study involved preoperative daily concurrent radiotherapy and chemotherapy with docetaxel (D) and cisplatin (C) using the HFT method for 41 patients with stage III, IV oral cancer. Clinical effects were complete response (CR) in 29 (82.9%) and partial response (PR) in 6 (17.1%) patients and pathological effects of the resected tumor were CR in 31 (88.6%) and PR in 4 (11.4%) patients, with a 5-year cumulative survival rate (overall rate) of 78.8%. Thus, the present study investigated the effectiveness of chemoradiotherapy using the HFT method without surgery for stage III, IV oral cancer. Methods: Patients (n = 16) with stage III, IV oral cancer were treated. A new catheter was prepared by modifying a 1.35-mm diameter angiographic catheter and inserting it superselectively using a guide wire to the feeding artery of the tumor via the superficial temporal artery. Long-term catheterization is possible by this method. Radiotherapy (total dose: 60 Gy) and superselective intra-arterial infusion chemotherapy using D (total dose: 60 mg/m2) and C (total dose: 100 mg/m2) were concurrently performed daily. Radical neck dissection was performed after chemoradiotherapy, but the primary lesions were preserved. Results: Toxicities over grade 3 were leukopenia (6.3%), mucositis (25.0%), and dermatitis (18.8%). No infection was associated with catherization. No major complications were observed. The clinical effects were CR in 13 (81.5%) patients, with recurrences in 3 patients. Salvage operations were performed in these 3 patients. The 3-year cumulative survival rate (overall rate) of 87.5% is higher than that of conventional therapy. Conclusions: Our HFT method, unlike the Seldinger method, allows for long-term catheterization, enabling daily concurrent chemoradiotherapy to be performed. This method promises to be the strategy of choice for the treatment of stage III, IV head and neck cancer. No significant financial relationships to disclose.

Daily concurrent preoperative chemoradiotherapy with docetaxel (D) and cisplatin (C) using new superselective intra-arterial infusion via superficial temporal artery (HFT method) for stage III, IV head and neck cancer

5567 Background: Recently, combined radiotherapy and intra-arterial chemotherapy using the Seldinger method was performed for head and neck cancers. However, chemotherapy and radiotherapy cannot be performed simultaneously on a daily basis because long-term catheterization is not possible. Therefore, we developed a new method of superselective intra-arterial infusion via the superficial temporal artery (HFT method reported by Hattori, Fuwa and Tohnai) and preoperatively performed daily concurrent radiotherapy and chemotherapy with D and C using this method for stage III, IV head and neck cancer. Methods: Forty-one patients with stage III, IV oral cancer were treated. A new catheter was prepared by modifying an angiographic catheter measuring 1.35 mm in diameter. This was inserted superselectively into the feeding artery of the tumor via the superficial temporal artery using a guide wire. Long-term catheterization is possible with this method. Radiotherapy (total dose: 40 Gy) and superselective intra-arterial infusion chemotherapy using D (total dose: 60 mg/m2) and C (total dose: 100 mg/m2) were concurrently performed daily, followed by surgery. Results: In 35 patients, intra-arterial infusion was successful, but 6 intra-arterial infusions were not successful due to arterial anomalies. Toxicities in excess of grade 3 were leukopenia of 8.6%, thrombocytopenia of 2.9%, mucositis of 20.0%, and dermatitis of 14.3%. No infection was associated with catheterization and no major complications were observed. The clinical effects were CR in 29 (82.9%) patients and PR in 6 (17.1%). Pathological effects of resected tumor after surgery were pathological CR in 31 (88.6%) patients and pathological PR in 4 (11.4%). The 5-year cumulative survival rate (overall rate) was 78.8%. This rate is higher than the rate associated with conventional therapy. Conclusions: Unlike the Seldinger method, superselective intra-arterial infusion allows for long-term catheterization and thus daily concurrent chemoradiotherapy can be performed. This method holds promise for treating stage III, IV head and neck cancer. No significant financial relationships to disclose.