Superselective Intra-arterial Chemoradiotherapy Research Articles

Efficacy of Paclitaxel and Cetuximab in Recurrent/Metastatic Oral Cancer Cases Following Superselective Intraarterial Chemoradiotherapy: A Retrospective Cohort Study.

The therapeutic efficacy of the paclitaxel (PTX) + cetuximab (Cmab) combination regimen was investigated in patients with recurrence or metastasis after superselective intraarterial chemoradiotherapy (SSIACRT) for oral cancer, and the safety was retrospectively examined. All enrolled patients with advanced oral cancer or who had refused surgery over 10 years from December 2012 to December 2022 underwent SSIACRT for 6 to 9 weeks [cisplatin (CDDP): total 160-630 mg/m2and radiotherapy: total 50-70 Gy]. Nine cases (tongue cancer, maxillary gingival cancer, and mandibular gingival cancer; three cases each) were subjected to PTX + Cmab therapy. Recurrence or metastases were observed within six months after the onset of treatment, complicating the conduct of salvage surgery. Cmab (first dose: 400 mg/m2and second and following doses: 250 mg/m2) and PTX (80 mg/m2) were administered weekly. The overall response rate was 44.4% (four of nine cases), and the disease control rate was 88.9% (eight of nine cases), whereas the median progression-free survival was seven months, and the overall survival was 11 months. Grade 3-4 adverse events were neutropenia in 33.3% of the cases, leukopenia in 55.6%, anemia in 22.2%, and acneiform skin rash in 22.2%. Based on the above, PTX + Cmab therapy for recurrent and metastatic cases after SSIACRT had comparable results to other second-line modalities and enabled to cope with the side effects of myelosuppression. PTX + Cmab therapy may be an effective treatment mode for recurrent or metastatic head and neck cancer resistant to CDDP after SSIACRT treatment.

Intra-arterial Chemotherapy for Head and Neck Cancer.

Superselective intra-arterial chemoradiotherapy for head and neck cancer is a combination of intensive local delivery of anticancer drugs using microcatheters and external beam radiation. Unlike conventional chemoradiotherapy, it is highly effective in treating the primary tumor, but it cannot treat distant metastases. In the field of head and neck cancer, where quality of life is significantly impaired by curative surgery from a functional and cosmetic point of view, it is a useful treatment not only for unresectable cases but also for resectable advanced cancers, with the maxillary sinus being a particularly good indication. This treatment is expected to outperform conventional systemic chemotherapy and even comes close to the outcomes of radical surgery if the patient is carefully selected and the appropriate technique is used. Currently, a multicenter phase III clinical trial to evaluate the efficacy of this treatment for maxillary sinus cancer has been completed, and the results are being analyzed.

Diameters of lingual, facial, and maxillary arteries measured according to an objective protocol on 3D computed tomography angiography images.

Retrograde superselective intra-arterial chemoradiotherapy is a radical treatment for advanced oral cancer. The catheter tip is placed into tumor-feeding arteries-the lingual, facial, or maxillary arteries. The diameter of the tumor-feeding arteries newly bifurcated from the external carotid artery is crucial for determining the requirement of a catheter navigation system. This study aimed to measure the diameter and distribution of the tumor-feeding artery according to an objective protocol using 3D computed tomography angiography images reproducibly. Angiographic data of 20 noncatheterized carotid arteriesof 10 randomly selected patients were analyzed. We followed the external carotid artery to the entrance of each feeding artery to determine the center point where the artery diameter was measured. The diameter of the optimum circle measured at the adopted center point was taken as the diameter of each tumor-feeding artery. The diameters (mean ± standard deviation) were 3.5 ± 0.45, 2.9 ± 0.56, and 3.5 ± 0.56mm for the maxillary, lingual, and facial arteries, respectively. The diameters of the maxillary and facial arteries were similar (p = 0.877), whereas the diameter of the lingual artery was smaller than that of the maxillary and facial arteries (p < 0.001). The findings of this study will be beneficial in determining the need of a new catheter navigation system and diameter of catheters to be used in the clinical practice. From the viewpoint of measurement automation and reproducibility, 3DCTA vessel measurement taken according to the proposed protocol was considered to be effective.

Neoadjuvant Superselective Intra-Arterial Cisplatin Chemoradiotherapy Combined With Surgery in Patients With T4 Squamous Cell Carcinoma of the Maxillary Sinus

Squamous cell carcinoma of the maxillary sinus (SCC-MS) is often diagnosed at a locally advanced stage, which is associated with poor prognosis. The purpose of the present study was to investigate clinical outcomes in patients with locally advanced T4 SCC-MS including originally inoperable T4b disease treated with neoadjuvant superselective intra-arterial chemoradiotherapy combined with surgery. This study is a retrospective case series. We examined clinical outcomes in the patients with T4 SCC-MS between 2005 and 2017. The outcome variables were 5-year overall survival rate, 5-year disease-free survival rate, and 5-year local control rate. Covariates included age, sex, T classification, N classification, stage classification, type of surgery, number of administrations and total dose of cisplatin, and radiation dose. Descriptive statistics were computed for each study variable. Ten patients with T4 SCC-MS (6 T4a and 4 T4b) were treated. All patients were men, and the median age was 60.5years (range, 45 to 77). Total maxillectomy was performed in 4 patients, and extended total maxillectomy in 6. The total number of intra-arterial chemotherapy administrations ranged between 2 and 4 for patients with T4a disease and between 3 and 4 for those with T4b disease. The median intra-arterial cisplatin dose was 360mg (range, 250 to 400) for patients with T4a disease and 360mg (range, 320 to 480) for those with T4b disease. The 5-year overall survival, 5-year disease-free survival, and 5-year local control rates of all patients were 100%, 70%, and 80%, respectively. The 5-year disease-free survival rate and 5-year local control rate were 83% and 83%, respectively, in the 6 T4a patients and 50% and 75%, respectively, in the 4 T4b patients. Neoadjuvant intra-arterial chemoradiotherapy in patients with T4 SCC-MS can achieve good clinical outcomes, and it may enable surgical resection of T4b lesions.

Assessment time of treatment response by PET-CT after superselective intra-arterial chemoradiotherapy for oral cancer

ObjectiveSuperselective intra-arterial chemoradiotherapy (SSIACRT) is an effective treatment for advanced oral cancer. However, in cases in which treatment is ineffective and the tumor remains, salvage operation is necessary; therefore, assessment of the treatment response is extremely important. With the use of fluorodeoxyglucose–positron emission tomography (FDG-PET)–computed tomography (CT) in addition to CT and magnetic resonance imaging, the accuracy improves for the assessment of treatment response. The study aimed to clarify factors that affect the accuracy rate of FDG-PET and FDG-PET scan time, considering the possibility of a salvage operation if the tumor remains. MethodsFrom April 2006 to March 2017, 69 patients (52 men and 17 women) who underwent SSIACRT and received PET were evaluated. ResultsThe average FDG-PET scan time for evaluating the treatment effect was 74.1 days (range, 48–126 days) after SSIACRT, and the rate of correct diagnosis was 75.4 %. All misdiagnoses were false positives. Multivariate analysis revealed that the correct diagnosis rate depended on the severity of oral mucositis (p = 0.025; odds ratio, 1.037). In 10 cases with residual tumor and five of six cases in whom size could be measured, no regrowth was observed in 3 months. Receiver operating characteristic curve analysis indicated that the time to obtain the correct diagnosis rate was 72 days. ConclusionsConsidering the state of oral mucositis, receiving FDG-PET after SSIACRT is appropriate at approximately 3 months; however, when oral mucositis is sufficiently improved, FDG-PET should be performed earlier.

Superselective intra-arterial chemoradiotherapy using altered blood flow compared to conventional systemic chemoradiotherapy for locally advanced oral squamous cell carcinoma: a single-center retrospective study.

To evaluate the efficacy and safety of superselective intra-arterial (IA) chemoradiotherapy with cisplatin and transcatheter arterial embolization (TAE) on advanced oral cancer, and to compare it with that of systemic chemoradiotherapy. This single-center retrospective study included 23 consecutive patients with locally advanced oral squamous cell carcinoma from November 2011 to November 2019. Of these, 15 received superselective IA cisplatin chemoradiotherapy with altered blood flow in the branches of the external carotid artery, and eight received systemic chemoradiotherapy. Medical charts were reviewed for the evaluation of patient data, drug toxicity, and antitumor efficacy. Local control rate for the superselective IA infusion group, who underwent 6-7 cycles was significantly higher than that of the systemic chemotherapy group (11/13, 85% vs 3/8, 38%; p = 0.04). Regional control, locoregional control, disease-free survival, and overall survival rates were not significantly different between the groups (p = 0.15-0.907). Acute toxicity rates of grade 3 or higher were not significantly different between the IA and IV chemotherapy groups (p = 0.221). Superselective IA chemoradiotherapy with cisplatin using altered blood flow in the branches of the external carotid artery with TAE may be useful for inoperable oral cancer.

Applicability of a single camera-based catheter navigation system using teeth arch as an anatomical landmark for superselective intraarterial infusion in advanced oral cancer treatment

Superselective intraarterial infusion chemoradiotherapy is a modality of oral cancer therapy in which the artery feeding the tumor is catheterized. 3D information about the carotid artery is required to enable the surgeon to judge whether to advance, retract, or rotate the catheter. For this purpose, we proposed and conducted a model experiment to assess a new method of catheterization that applies a tracking system using registration with a monocular camera using the maxillary arch as the anatomical landmark. In this method, the preoperative 3D computer tomography angiographic image of the carotid artery that the catheter will be passed through is overlaid on the 2D video image. The mean TRE was 0.96 ± 0.36 mm and 0.88 ± 0.31 mm and 1.12 ± 0.46 mm when images were registered with the anterior and posterior teeth as the landmarks, respectively; the difference was not significant (p = 0.21). This tracking system that enables markerless registration simply by taking images of the maxillary anterior teeth with a single camera was convenient and effective for catheterization. In this study, we propose the new application of this tracking system and a novel method of catheterization for superselective intraarterial infusion chemoradiotherapy for oral cancer.Graphical abstractIn retrograde superselective intraarterial catheterization, a catheter is inserted into a tumor-feeding artery originating from the external carotid artery (ECA) (the lingual artery [LA], facial artery [FA], or maxillary artery [MA]). Because the maxillary dentition is located near the external carotid artery, we focused on real-time markerless registration using maxillary dentition fixed to the skull.

Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors

BackgroundWe compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC).MethodsWe included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n = 66; SCRT group: n = 18).ResultsThe median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6, 95% CI: 62.7–85.2; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2, 95% CI: 64.2–86.4; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups.ConclusionsThis is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.

Investigation of distant metastasis occurrence rates with different treatments: A comparison of superselective intra‐arterial chemoradiotherapy and surgery

AbstractControl of distant metastasis is an important factor in improving treatment outcomes for oral cancer. Superselective intra‐arterial chemoradiotherapy (SSIACRT) has been reported to be effective for preservation of form and function, thus enabling a satisfactory outcome. However, there have also been reports of a high frequency of distant metastases with SSIACRT. The present study therefore aimed to clarify whether treatment method has any relationship with the onset of distant metastases. Of a total of 384 cases of oral cancer, 270 underwent surgery, 44 underwent surgery followed by radiotherapy, and 70 underwent SSIACRT, and distant metastases occurred in 42 cases. On multivariate analysis, only N classification was a significant risk factor (P = .0001, odds ratio = 1.848). This confirmed that the only risk factor for distant metastases is lymph node metastasis, there is no relationship to treatment method, and there are no grounds to say that SSIACRT promotes distant metastases.

Prognostic value of quantitative FDG-PET in the prediction of survival and local recurrence for patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy.

The current study aimed to evaluate the relationship between 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET-CT) standardized uptake value (SUV) [pre-treatment SUV (pre-SUV) and post-treatment SUV (post-SUV)] and treatment results in patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy (SSIACRT). A total of 37 patients with advanced oral cancer were treated with SSIACRT. The treatment consisted of superselective intra-arterial chemotherapy (docetaxel (DOC) 40 mg/mm2 and nedaplatin (CDGP) 80 mg/mm2) and concurrent radiotherapy (60–70 Gy) for a period of seven weeks. Pre-SUV and post-SUV of the primary tumor were measured. Overall survival (OS) and local control (LC) rates were selected as endpoints to evaluate prognosis. The median follow-up was 40 months (range 6–112 months). The 5-year OS and LC rates were 64.5 and 85.5%, respectively, and SSIACRT achieved high LC rate even in advanced oral cancers. In the log-rank test, post-SUV was a significant prognostic factor for OS and LC rates. The results of the current study demonstrated that SSIACRT is a reliable treatment with respect to survival in advanced oral cancer and post-SUV was a significant prognostic factor for OS and LC rates.

Thermochemoradiotherapy Using Superselective Intra-arterial Infusion for Patients With Oral Cancer With Cervical Lymph Node Metastases.

We aimed to retrospectively investigate the outcomes and pathological effects of retrograde superselective intra-arterial chemoradiotherapy (IACRT) combined with hyperthermia on metastatic lymph nodes of patients with oral squamous cell carcinoma. Patients with lymph node metastasis from oral cancer were treated with IACRT using cisplatin plus docetaxel combined with hyperthermia prior to surgical removal 8 weeks after completion of IACRT and hyperthermia. The locoregional control and overall survival rates were calculated using the Kaplan-Meier method. A total of 35 patients received the combination therapy of whom 26 received it as definitive treatment and in the rest, it was administered as preoperative treatment. The 5-year locoregional control and overall survivaI rates were 95.6% and 80.2% in the definitive-treatment group, and 100% and 66.6% in the preoperative-treatment group, respectively. The combination therapy provided good outcomes in patients with lymph node metastases from advanced oral cancer.

Swallowing function in advanced tongue cancer patients before and after bilateral neck dissection following superselective intra-arterial chemoradiotherapy for organ preservation: a case-control study.

This study aimed to evaluate swallowing function in advanced tongue cancer patients before and after bilateral neck dissection following superselective intra-arterial chemoradiotherapy (CRT). A videofluoroscopic swallowing study (VFSS) was used to evaluate swallowing function in 10 patients with advanced tongue cancer before and after bilateral neck dissection. Laryngeal penetration increased in the postoperative VFSS. Temporal analysis comparing two time points revealed that, after surgery, oral transit time increased significantly, but there was no difference in pharyngeal delay time or pharyngeal transit time. Spatial analysis revealed significant decreases after surgery in the maximum distance of upper esophageal sphincter (UES) opening, the maximum distance of hyoid bone movement in both the anterior and superior direction, and the maximum velocity of hyoid bone movement. Laryngeal penetration and aspiration increased as a result of limited hyoid movement and diminished UES opening after bilateral neck dissection following superselective intra-arterial CRT for advanced tongue cancer.

Chemoradiotherapy using retrograde superselective intra-arterial infusion for tongue cancer: Analysis of therapeutic results in 118 cases

ObjectivesTo evaluate the therapeutic results and rate of organ preservation in patients with squamous cell carcinoma of the tongue treated with retrograde superselective intra-arterial chemoradiotherapy. Materials and methodsBetween June 2006 and June 2015, 118 patients with tongue cancer were treated with intra-arterial chemoradiotherapy. Treatment consisted of radiotherapy (total 50–70 Gy) and daily concurrent intra-arterial chemotherapy (docetaxel, total 50–70 mg/m2; cisplatin, total 125–175 mg/m2) for 5–7 weeks. Locoregional control and overall survival rates were calculated by the Kaplan-Meier method. Cox’s proportional hazards model was used for both univariate and multivariate analyses. ResultsThe median follow-up for all patients was 38.5 months (range, 3–129 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 113 (95.8%) of 118 cases. Three-year locoregional control and overall survival rates were 80.3% and 81.5%, respectively. Grade 3 or 4 toxicities included neutropenia in 16.1% and mucositis in 87.3%. Grade 3 toxicities included anemia in 12.7%, thrombocytopenia in 3.4%, nausea/vomiting in 3.4%, dermatitis in 45.7%, dysphagia in 74.6%, and fever in 2.5% of patients. Late toxicity consisting of grade 3 osteoradionecrosis of the jaw occurred in 4.2% of patients. On univariate analysis, T stage and overall stage were significantly associated with locoregional control, and N stage and overall stage were significantly associated with overall survival. On multivariate analysis, the only significant predictor of overall survival was overall stage classification. ConclusionRetrograde superselective intra-arterial chemoradiotherapy for tongue cancer provided good overall survival and locoregional control.

Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting pathological response to preoperative super-selective intra-arterial chemoradiotherapy for advanced squamous cell carcinoma of the mandible

IntroductionAlthough chemoradiotherapy (CRT) for oral squamous cell carcinoma (SCC) has been shown to preserve organ function and improve cosmetic results, site-specific data, especially mandible, are limited. The aim of this study was to evaluate the predictability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on response to super-selective intra-arterial CRT for advanced SCC of the mandible. MethodsFifteen patients with advanced SCC of the mandible underwent super-selective intra-arterial CRT followed by radical resection. Maximum standardized uptake value (SUVmax) of the mandibular lesion was evaluated with FDG-PET/CT before and after CRT. The SUVmax before and after CRT was defined as pre-SUVmax and post-SUVmax, respectively. The difference between pre- and post-SUVmax was calculated as SUVmax reduction rate to evaluate treatment response of the mandibular lesion. Each SUVmax reduction rate and surgical specimen of the corresponding lesion was analyzed to evaluate an accuracy of the modality for predicting pathological response. ResultsThe median of pre-SUVmax was significantly lower than that of post-SUVmax (p = 0.001). Of the 15 patients, 6 had a pathological complete response (pCR) and 9 had a non-pCR. Neither pCR patients nor non-pCR patients showed significant difference of the median of SUVmax between pre- and post-CRT (pre-CRT p = 0.099 post-CRT p =0.074). The SUVmax reduction rate in patients with pCR was significantly higher than that with non-pCR (p = 0.002). Receiver operating characteristic analysis revealed that the optimal cut-off point of the reduction rate was 64.7%, with 83% sensitivity and 100% specificity. ConclusionsThese results concluded that SUVmax reduction rate can predict pathological complete response of preoperative super-selective intra-arterial CRT for advanced SCC of the mandible.

Retrograde superselective intra-arterial chemoradiotherapy combined with hyperthermia and cetuximab for carcinoma of the buccal mucosa with N3 lymph node metastasis: a case report

We herein report a case of squamous cell carcinoma of the buccal mucosa with N3 cervical lymph node metastasis in a 63-year-old man. The patient was treated with combination therapy comprising radiotherapy (2Gy/day, total of 70Gy), superselective intra-arterial chemotherapy via a superficial temporal artery (docetaxel, total of 70mg/m2 and cisplatin, total of 175mg/m2), cetuximab (initial dose of 400mg/m2 with subsequent weekly doses of 250mg/m2 intravenously), and four sessions of hyperthermia for cervical lymph node metastases. The patient responded well to the therapy, with a complete response of the primary tumor. Radical neck dissection was performed with reconstructive surgery, including resection of the overlying skin. A pathologic complete response was achieved for the N3 and all other cervical lymph node metastases. The patient showed no evidence of recurrence in the 3years following treatment. Based on the findings in the present case, the use of retrograde superselective intra-arterial chemoradiotherapy combined with hyperthermia and cetuximab seems to be a promising modality for patients with N3 cervical lymph node metastasis of oral cancer.

Hard plate cancer treated with superselective intra-arterial chemoradiotherapy via bilateral superficial temporal arteries: a case study

Hard plate cancer treated with superselective intra-arterial chemoradiotherapy via bilateral superficial temporal arteries: a case study

A case of tongue cancer that was treated by bolus injection from anastomotic branch after the obstruction of the tumor-feeding arteries during retrograde super-selective intra-arterial chemoradiotherapy

A case of tongue cancer that was treated by bolus injection from anastomotic branch after the obstruction of the tumor-feeding arteries during retrograde super-selective intra-arterial chemoradiotherapy

Treatment efficacy of retrograde superselective intra-arterial chemoradiotherapy for locally advanced maxillary gingival cancer

Treatment efficacy of retrograde superselective intra-arterial chemoradiotherapy for locally advanced maxillary gingival cancer

Prognostic value of volumetric FDG PET/CT parameters in patients with oral tongue squamous cell carcinoma who were treated by superselective intra-arterial chemoradiotherapy.

This study aimed to evaluate the predictive and prognostic value of FDG PET/CT-based volumetric parameters in patients with oral tongue squamous cell carcinoma (OTSCC) treated by superselective intra-arterial chemoradiotherapy (IA-CRT). We conducted a retrospective study including 33 patients with biopsy-proven OTSCC between May 2007 and February 2016. All of the patients were treated by IA-CRT. Pretreatment SUVmax and metabolic tumor volume (MTV) of the primary tumor were measured. The SUV thresholds of 2.5 and 5.0 were used. Progression-free survival (PFS) and overall survival (OS) were chosen as endpoints to evaluate prognosis. Univariate and multivariate analyses were performed to assess the potential independent effect of FDG PET/CT parameters. The median follow-up for surviving patients was 40.7months (range 6.0-107.5months). In univariate and multivariate analyses, SUVmax and MTV (5.0) were independent prognostic factors for PFS. In univariate analysis, SUVmax failed to predict OS. MTV (5.0) was a significant prognostic factor for OS, but multivariate analysis failed to show statistical independence because it could not exclude the possibility of an artifact due to N stage. FDG PET/CT-based volumetric parameters may be significant prognostic markers for survival of patients with OTSCC who are treated by IA-CRT.

Systematic review: Is there any evidence for utilisation of super-selective intra-arterial (IA) chemoradiotherapy in external auditory canal (EAC) tumours over conventional therapy?

Systematic review: Is there any evidence for utilisation of super-selective intra-arterial (IA) chemoradiotherapy in external auditory canal (EAC) tumours over conventional therapy?