Intra-arterial Chemotherapy for Malignant Tumors of Head and Neck Region Using Three Types of Modified Injection Method

Abstract

Relatively higher infusion rate in the intra-arterial chemotherapy (IA chemotherapy) could induce the higher concentration and the more sufficient distribution of chemotherapeutic agents on tumors. To get the relatively higher infusion rate in IA chemotherapy, we used three types of injection method: high-flow injection, high-dose injection with detoxification and flowcontrolled injection method for the treatment of malignant brain tumors, skull base tumors and head and neck tumors. Between January 1997 and October 2001, twenty-seven patients (mean age 61 y.o.) with supratentorial glioblastoma (4 cases), supratentorial anaplastic astrocytoma (1), CNS lymphoma (2), matastatic skull base tumors (3), and neck tumors (15 squamous cell carcinoma, 1 malignant melanoma and 1 neuroblastoma) received our three types of IA chemotherapy. Sixty- five consecutive procedures were performed. Conventional radiation therapy and/or surgical removal were performed in some of these patients. The median follow-up period was 10 months ranging 2 to 56 months. Fifteen (55.6%) and 6 (22.2%) of 27 patients achieved complete response (CR) and partial response (PR) respectively after initial treatment [CR+PR: 21 (77.8%)]. All responded patients showed clinical improvement. The response rate declined to 55.6% at the end of follow-up period. Eighteen patients are still alive and 15 of them show no evidence of local recurrence. The median post treatment survival was 12 months. There was no serious complication except transient nausea in 4 of 27 (14%) patients, vertigo and granulocytopenia in 1 each (3%) of 27 patients. Our modified IA chemotherapy has provided favorable clinical and radiological results without technical difficulties and serious complications.

Figure 1

Case 1: High-flow injection. A 47 year-old man with right frontal glioblastoma. A) Preoperative Tl-weighted Gd-enhanced image demonstrating a large enhanced mass in right frontal lobe. B) Follow-up MR images obtained one year after the initial treatment (surgical removal and conventional radiation therapy). No evidence of tumor was shown. C) MR images revealing recurrence of tumor obtained 33 months after the initial treatment. D) MR images revealing markedly reducing enhanced lesion and perifocal edema in the bilateral frontal lobes 6 months after the first high-flow intra-arterial injection of ACNU.

Figure 2

Case 1: Highflow injection. Internal carotid angiogram during three different flow rate m]ection of contrast medium. Cerebral arteries during low flow rate injection were not filled fully by contrast medium because of streaming phenomenon. A) low flow rate (10ml/min), B) medium flow rate (20ml/min), C) high flow rate (30ml/min).

Figure 3

Case 2: High-dose injection with detoxification. A 73 year-old woman with squamous cell carcinoma of maxillary sinus. A) External carotid angiogram revealing hypervascular mass in maxillary sinus fed mainly by internal maxillary artery. B) Selective internal maxillary arteriogram just before high-dose CDDP injection. C) Venogram showing another catheter placed into anominate vein via femoral vein. Sodium thiosulfate (STS) was administered to reduce systemic adverse effect of the chemotherapeutic agent.

Figure 4

Case 3: Flow-controlled injection. A 61 year-old man with skull base metastasis from hepatocellular carcinoma. A) Initial contrast enhanced CT scans demonstrating enhanced mass lesions involving sphenoid sinus and left temporal bone with bone destruction. B) Contrast enhanced CT scans obtained 1 year after 4 sessions of ñow controlled injection of CDDP. No evidence of residual tumor was shown.

Figure 5

Case 3: Flow-controlled injection. A) Left external carotid angiograms obtained before inflating the balloon. B) Left external carotid angiograms during flow-controlled injection revealing increased concentration of contrast-enhanced material to the tumor.