title: [Usefulness and indication of superselective intra-arterial chemotherapy via the radial artery for advanced head and neck cancer--aN indication for inaccessible to treatment with seldingers method].
abstract: Neck metastasis is the most significant predictive indicator of head and neck cancer. Various treatments including surgery and chemoradiation have typically resulted in poor outcomes. As a result, we have applied progressive interventional radiology (IVR), Seldinger's method, in cases deemed to have poor prognostic factors. However, a recurring problem with the standard procedure has been cases in which the target artery cannot be successfully accessed. As a result of this limitation, we have initiated an approach whereby we proceed from the radial artery in order to control neck metastasis.
  
  
  OBJECTIVE
  Evaluate the usefulness of superselective intra-arterial chemotherapy via the radial artery for advanced head and neck cancer.
  
  
  METHODS
  From May, 1998 to December 2010, 25 patients for whom catheter insertion in the thyrocervical artery, a major branch of the subclavian artery, was impossible, were treated using superselective intra-arterial chemotherapy via the radial artery. Intra-arterial chemotherapy was administered at 100-150 mg/m2 of CDDP and 10-15 mg/m2 of DOC four times per week, with 60 Gy radiation therapy being concurrently. Analysis of the success of insertion, duration of time required for insertion to the target artery, chemotherapy effective rates, and method safety were carried out retrospectively.
  
  
  RESULTS
  For the target arteries in which catheters could not be effectively inserted using Seldinger's method, insertion was successful and CDDP was safely administered. No complications in regards to intra-arterial chemotherapy were observed. The mean time to insert the catheter into the target arteries was approximately 25 minutes. In contrast, when applying Seldinger's method the mean time was over 1 hour with the result being failure to insert the catheter within the target arteries. Working with our approach, the effective rate of chemotherapy recorded was 100%. The 5-year overall survival rate was 38%. Furthermore, the patients could walk and move freely on the day of treatment.
  
  
  CONCLUSIONS
  This novel method proved useful for the treatment of advanced head and neck cancer in poor prognostic cases in which the target arteries could not be accessed using Seldinger's method.
authors: Department of Otolaryngology, Head and Neck Surgery, Juntendo University School of Medicine.
authors: Junkichi
authors: J
authors: Yokoyama
authors: Shin
authors: S
authors: Ito
authors: Shinichi
authors: S
authors: Ohba
authors: Mitsuhisa
authors: M
authors: Fujimaki
authors: Katsuhisa
authors: K
authors: Ikeda
authors: Makoto
authors: M
authors: Hanaguri
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017534:Radial Artery / Q000473:pathology*; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
chemical_list: D043823:Taxoids; D002945:Cisplatin; D005472:Fluorouracil