Review of the Literature. Super-selective Chemotherapy with High Dose Carboplatin for Advanced Cervicofacial Tumours. Treatment Validation and Preliminary Findings in 22 Patients.
Traditional treatment based on surgery combined with radiotherapy for stage III and IV cervicofacial squamous cell carcinomas has shown disappointing results to date. In the past, systemic chemotherapy was only used as a palliative treatment. Intra-arterial chemotherapy offers theoretical advantages mainly linked to increased drug tolerability. This new technique seems particularly suited to the management of squamous cell carcinomas in view of the local and regional spread of these tumours and the improved access by means of angiographic adminstration through the branches of the external carotid artery. We describe our experience of intra-arterial chemotherapy in 22 patients with biopsy-proven squamous cell carcinoma at the onset of disease. High dose Carboplatin (300-350 mg/m(2)) was super- selectively injected by rapid infusion repeated in three sittings at two week intervals. The optimum point of drug infusion was determined in each patient on the basis of angiographic information obtained in the diagnostic work-up. The dual objective was to get as near as possible to the primary tumour and to infuse the drug into any satellite lymph node metastases. The narrow calibre and tortuous course of the branches of the external carotid artery increase the likelihood of vasospasm: 5F hydrophilic catheters proved very useful to minimize technical complications in all angiographic procedures performed (64). Treatment was always well tolerated with mild local toxicity (grade 1-3, WHO), mainly involving the mucosae (stomatitis) and skin (dermatitis and alopecia) and minimum myelosuppression (grade 1-2, WHO). A positive response (complete or partial tumour remission) was observed in 94% of patients with primary tumours and in 50% of cases with cervical lymph node metastases. The reduction in tumour size often precluded the need for surgery and the cycles of chemotherapy were followed only by target radiotherapy for the tumour residue.
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U.O. di Neuroradiologia Terapeutica e Vascolare, IRCCS Istituto Neurologico <<Fondazione C. Mondino>>; Pavia, Italy.
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