Oral and maxillofacial surgery
Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for T2-4N0 tongue cancer: control of occult neck metastasis

https://doi.org/10.1016/j.oooo.2017.02.004Get rights and content

Objective

To evaluate the therapeutic results and control of occult neck metastasis in patients with T2-4N0 oral tongue squamous cell carcinoma treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy.

Study Design

Forty-two patients with T2-4N0 tongue cancer (17 with late T2; 13 with T3; and 12 with T4a disease, M0) were treated with intra-arterial chemoradiotherapy. Treatment consisted of retrograde superselective intra-arterial chemotherapy (docetaxel 50-70 mg/m2, cisplatin 125-175 mg/m2) and daily concurrent radiotherapy (50-70 Gy) for 5-7 weeks.

Results

The median follow-up for all patients was 46.5 months (range, 8-105 months). Primary-site complete response was achieved in 42 of 42 cases (100%). Three-year overall survival, progression-free survival, and local control rates were 85.0%, 77.8%, and 91.7%, respectively. Delayed neck metastasis was detected in 5 of 42 cases (11.9%). Grade 3 or 4 toxic changes included oral mucositis in 92.9%, neutropenia in 21.4%, and thrombocytopenia in 4.8%. Grade 3 toxicities included anemia in 16.7%, radiation dermatitis in 9.5%, nausea in 4.8%, and fever in 2.4%.

Conclusions

Retrograde superselective intra-arterial chemotherapy for T2-4N0 tongue cancer provided good overall survival and local control rates and was effective for occult neck metastasis.

Section snippets

Patients

Between August 2006 and March 2015, 97 patients with tongue SCC were treated with retrograde superselective intra-arterial CRT. Of these, 42 patients (29 male and 13 female; median age 63.5 years; age range, 34-87 years) with late T2 (>3 cm), T3, or T4a N0M0 underwent intra-arterial CRT (Table I). All patients were primary cases and had not received previous chemotherapy, radiotherapy, or surgery. The primary lesion and cervical lymph nodes were assessed by enhanced computed tomography (CT),

Treatment results

The median follow-up period was 46.5 months (range, 8-105 months). After retrograde superselective intra-arterial CRT, primary tumor CR was achieved in 42 cases (100%). Three of 42 cases (7.1%) showed local recurrence during follow-up. Delayed neck metastasis was detected in 5 cases (11.9%): 2 T2, 1 T3, and 2 T4a (Table II). In 4 of 5 cases, delayed neck metastasis was observed in the neck area that had no perfusion of anticancer drugs. In the other case, both the primary lesion and neck showed

Discussion

Superselective intra-arterial infusion for head and neck cancer has the advantage of delivering a high concentration of anticancer drugs to the tumor. Lee et al.14, 15 reported superselective intra-arterial chemotherapy via the femoral artery by the Seldinger method. Robbins et al.16, 17 reported the effectiveness of rapid intra-arterial administration of high-dose CDDP combined with radiotherapy and sodium thiosulfate neutralization. We developed a regimen of retrograde superselective

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