Daily Cisplatin and Weekly Docetaxel versus Weekly Cisplatin Intra-Arterial Chemoradiotherapy for Late T2-3 Tongue Cancer: A Pilot and Feasibility Trial

Abstract

Background and objectives: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in the present study. In the DIACRT group, 25 patients had late T2, and 20 patients had T3. A total of nine patients had late T2 and two had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months, respectively. The five-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for the DIACRT group, and 60.6% and 63.6% for the WIACRT group, respectively. The LC rate and OS of the DIACRT group were significantly higher than those of the WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods in both groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.

Keywords: head and neck cancer; intra-arterial chemotherapy; oral cancer; radiotherapy.

Figure 1

A Flowchart of the Study Design. All patients treated with weekly cisplatin (CDDP) intra-arterial chemoradiotherapy (WIACRT) were enrolled in the study (n = 11). A total of 45 patients with late T2-3 disease were selected from 96 patients treated with daily CDDP and weekly docetaxel (DOC) intra-arterial chemoradiotherapy (DIACRT) to get comparability between two groups.

Figure 2

A Digital Subtraction Angiogram (DSA) and an Axial View of the Angio-CT Image through Retrograde Intra-arterial Infusion (Right Tongue Cancer: T3N0M0). (A) A DSA of the right lingual artery (LA). The catheter was selectively inserted into the right LA via the occipital artery (black arrowhead: the tip of the catheter). (B) An axial view of the angio-CT image after the infusion of a small amount of contrast medium through the catheter. Tumor staining of the right side of the tongue is seen through the right LA (white arrowhead).

Figure 3

Treatment Schedule of DIACRT and WIACRT. In daily cisplatin (CDDP) and weekly docetaxel (DOC) intra-arterial chemoradiotherapy (DIACRT), the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy) for six weeks. In weekly CDDP intra-arterial chemoradiotherapy (WIACRT), the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy) for six weeks.

Figure 4

(A) The five-year Local Control (LC) and (B) Overall Survival (OS) Rates of the DIACRT and WIACRT Groups. The five-year LC and OS were 94.5% and 89.6% for the DIACRT group, and 60.6% and 63.6% for the WIACRT group, respectively. The LC and OS rate in the DIACRT group were significantly higher than those in the WIACRT group (p = 0.007 and 0.027, respectively). Abbreviations: OS, overall survival; LC, local control.