Chemoembolization of oral and oropharyngeal cancer using a high-dose cisplatin crystal suspension and degradable starch microspheres

Abstract

The aim of the study was to achieve intensification of intraarterial chemotherapy of head and neck cancer with high-dose cisplatin by establishing a new method of chemoembolization which can be routinely used without the earlier drawbacks of the method (low drug dosage due to early occlusion of the small head and neck vessels, danger of local damage). Thirty two patients with previously untreated oral and oropharyngeal squamous cell carcinomas of all stages were treated by at least one superselective chemoembolization via femoral approach using a new preparation format of 150 mg/m(2) cisplatin which is an aqueous crystal suspension. In defined cases, combination with the delivery of degradable starch microspheres (DSM). Systemic neutralization with sodium thiosulfate. Primary end points were tolerance and response. Subsequent treatment was surgery or radiation. Chemoembolization succeeded in all 37 interventions to date. Overall response after one cycle was 64.7% using the cisplatin crystal suspension only (n=17) and 86.6% using additional DSM chemoembolization (n=15), as assessed 3 weeks after treatment. Systemic toxicity was extremely low, local side-effects (pain, swelling, small necrosis) were pronounced after additional delivery of DSM. There have been three complications (tracheotomy due to swelling, temporary facial paralysis twice due to embolization of the geniculate ganglion). Using the high-dose cisplatin crystal suspension, chemoembolization can routinely be used in the head and neck area as neoadjuvant therapy. Response was better than with former comparable regimens. The additional delivery of DSM was complicated, restricted to certain areas and unreliable in the dosage needed and might be omitted, therefore.