[Intratumoral chemotherapy: experimental data and applications to head and neck tumors].
OBJECTIVE
Intratumoral chemotherapy consists in the direct intratumoral injection of the anticancer drugs. Despite its simple and logical principle it remains relatively little used.


METHODS
This work reviews and analyses the national and international literature about experimental and clinical studies of intratumoral chemotherapy.


RESULTS
Numerous experimental studies validated its theoretical advantages compared with the intravenous one: drug intratumoral concentration increase, antitumoral activity improvement and systemic toxicity decrease. But they also underlined its limits: the high clearance and the non-homogeneous drug diffusion. Research works led to the improvement of the results and performed clinical trials with slow release devices (microspheres, collagen matrix with or without vasoconstrictive agent), anticancer drug in an aqueous solution with a vasoconstrictive agent, intratumoral injection in association with electrochemotherapy or radiotherapy. These trials showed the feasibility of this technique with, in recurrent tumors, response rate between 27 and 50% and an increase in quality of life. The more frequent adverse effects were pain in 24 to 80% of cases, ulceration, necrosis and oedema of the treated locations in 53 to 87,4% of cases and during the use of vasoconstrictive agents systemic effects like arterial hypertension and extrasystoles.


CONCLUSIONS
Intratumoral chemotherapy is an effective therapeutic even when used after the classical treatments. Improvements are necessary to define the best drugs, injection technique, treatment periodicity and indications. Intratumoral chemotherapy deserves better interest at the moment where drugs and antibodies limit their action to the cancer cells preserving the healthy ones.
Duvillard
C
C
Service d'Otorhinolaryngologie et de Chirurgie Cervicofaciale, Hôpital Général, CHU de Dijon, 21033 Dijon cedex, France. christian.duvillard@chu-dijon.fr
Polycarpe
E
E
Romanet
P
P
Chauffert
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004333:Drug Administration Routes; D004558:Electric Stimulation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged