Regional infusion chemotherapy for cancer of the head and neck

Abstract

The experience with intraarterial infusion chemotherapy in the 24 years since its development has established that it is not a substitute for conventional methods of management. Its prime indications are for palliation of advanced and recurrent cancer unsuitable for irradiation or surgery or as an adjunct to the latter. Several specific observations are relevant to its use in the head and neck region: 1. With currently available antineoplastic agents more than half of the neoplasms in this region can be made to regress. Epidermoid carcinomas, the most frequent tumor of the head and neck, as well as less frequent carcinomas and sarcomas can be affected. 2. Regressions are usually incomplete and brief, lasting but a few months, and despite complete tumor regression microscopic cancer usually persists. Occasionally, unpredictably, and for uncertain reasons a regression is complete and permanent. Small, well-differentiated and exophytic (verrucous) epidermoid cancers appear most liable to such a response. 3. Temporary or permanent neurologic damage is the most distressing morbidity associated with treatment. This hazard can be minimized by avoiding infusion of the internal carotid artery and protection of the patient from embolism of air or particulate matter through catheters. 4. The combined use of two or more chemotherapeutic agents is promising as a means for increasing the frequency and possibly the duration of tumor regressions. 5. The value of infusion as an adjunct to irradiation or surgery for potentially curable cancers is still unproved. Uncontrolled data suggest that local control of cancer may be improved, particularly if all three modalities are combined. A controlled clinical trial by experienced investigators could resolve this issue. 6. Although the arterial route increases the activity of some chemotherapeutic agents, significant progress appears to depend upon the development of drugs with greater specificity for neoplastic tissues. 7. In its present form, arterial infusion chemotherapy offers a brief period of palliation to many patients with cancer of the head and neck who are otherwise untreatable, and occasionally to such individuals a final chance for cure.