title: Thermochemoradiation therapy using superselective intra-arterial infusion via superficial temporal and occipital arteries for oral cancer with N3 cervical lymph node metastases.
abstract: OBJECTIVE
  To evaluate the therapeutic results and histopathological effects of treatment with thermochemoradiation therapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries for N3 cervical lymph node metastases of advanced oral cancer.
  
  
  METHODS
  Between April 2005 and September 2010, 9 patients with N3 cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiation therapy using superselective intra-arterial infusion with docetaxel (DOC) and cisplatin (CDDP). Treatment consisted of hyperthermia (2-8 sessions), superselective intra-arterial infusions (DOC, total 40-60 mg/m(2); CDDP, total 100-150 mg/m(2)) and daily concurrent radiation therapy (total, 40-60 Gy) for 4-6 weeks.
  
  
  RESULTS
  Six of 9 patients underwent neck dissection 5-8 weeks after treatment. In four of these 6 patients, all metastatic lymph nodes, including those at N3, were grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) tumors, as classified by the system by Shimosato et al (Shimosato et al Jpn J Clin Oncol 1971;1:19-35). In 2 of these 6 patients, the metastatic lymph nodes were grade 2b (destruction of tumor structures with a small amount of residual viable tumor cells). The other 3 patients did not undergo neck dissection due to distant metastasis after completion of thermochemoradiation therapy (n=2) and refusal (n=1). The patient who refused neck dissection underwent biopsy of the N3 lymph node and primary sites and showed grade 3 cancer. During follow-up, 5 patients were alive without disease, and 4 patients died due to pulmonary metastasis (n=3) and noncancer-related causes (n=1). Five-year survival and locoregional control rates were 51% and 88%, respectively.
  
  
  CONCLUSIONS
  Thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and locoregional control rates in patients with N3 metastatic lymph nodes. However, patients with N3 metastatic lymph nodes experienced a high rate of distant metastases.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. mitsudo@yokohama-cu.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Koizumi
authors.forename: Masaki
authors.initials: M
authors.lastname: Iida
authors.forename: Toshinori
authors.initials: T
authors.lastname: Iwai
authors.forename: Senri
authors.initials: S
authors.lastname: Oguri
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Itoh
authors.forename: Mitomu
authors.initials: M
authors.lastname: Kioi
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirota
authors.forename: Iwai
authors.initials: I
authors.lastname: Tohnai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D017115:Catheter Ablation / Q000295:instrumentation; D002536:Cerebral Arteries; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D000077143:Docetaxel; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007261:Infusions, Intra-Arterial / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000628:therapy*; D009333:Neck; D037981:Neck Dissection / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D043823:Taxoids / Q000008:administration & dosage; D013699:Temporal Arteries
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin