Secure Surgical Method for Catheter Placement via the Occipital Artery to Achieve Retrograde Superselective Intra-Arterial Chemotherapy for Advanced Oral Cancer: Alternative to Approach via the Superficial Temporal Artery

We describe secure surgical method for catheter placement using ultrasonic scalpel via the occipital artery to achieve retrograde superselective intra-arterial chemotherapy for advanced oral cancer, as alternative to approach via the superficial temporal artery.     

Intra-arterial chemotherapy for head and neck cancer

There are historically speaking, three methods of intra-arterial infusion for head and neck cancer. Recently, daily concurrent chemoradiotherapy using new superselective intra-arterial infusion via superficial temporal arterial artery is noted. A catheter with a curved tip is inserted superselectively to the feeding artery of the tumor via the superficial temporal artery. Long-term catheterization is possible in this method. Thirty-five patients with stage III or IV oral cancer were treated. Radiotherapy (total dose:40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2, 15 mg/m2/week) and CDDP total dose: 100 mg/m2, 5 mg/m2/day) were concurrently performed daily, followed by surgery. In 31 patients, intra-arterial infusion was successful(successful rate: 88.6%), and no major complication was observed. The clinical effects were CR in 25 patients(80.6%), and pathological effects of resected tumor after surgery were pathological CR in 28 (90.3%). This method promises to be new strategy of choice for the treatment of head and neck cancer.     

Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: Analysis of therapeutic results in 112 cases

Purpose

To evaluate the therapeutic results and rate of organ preservation in patients with stage III or IV oral cancer treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy.

Materials and methods

One hundred and twelve patients with stage III and IV oral squamous cell carcinoma underwent intra-arterial chemoradiotherapy. Catheterization from the superficial temporal and occipital arteries was performed. Treatment consisted of superselective intra-arterial chemotherapy (docetaxel, total 60 mg/m², cisplatin, total 150 mg/m²) and daily concurrent radiotherapy (total of 60 Gy) for 6 weeks.

Results

The median follow-up for all patients was 46.2 months (range, 10–76 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 98 (87.5%) of 112 cases. Five-year survival and local control rates were 71.3% and 79.3%, respectively. Grade 3 or 4 toxicities included mucositis in 92.0%, neutropenia in 30.4%, dermatitis in 28.6%, anemia in 26.8%, and thrombocytopenia in 7.1% of patients. Grade 3 toxicities included dysphagia in 72.3%, nausea/vomiting in 21.4%, fever in 8.0%, and renal failure in 0.9% of patients.

Conclusion

Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer provided good overall survival and local control.     

Usefulness of CT-angiography for superselective intra-arterial chemotherapy for advanced head and neck cancers

Eighteen N3 cases, fourteen skullbase invasion cases and twenty-six cases of paranasal sinus cancer with orbital invasion were treated by superselective intra-arterial chemotherapy using CDDP and sodium thiosulfate to preserve the organs and to improve poor prognosis. In these patients, 100-150 mg/m2 of CDDP was administered weekly to each feeding artery of the tumor superselectively at 5 mg/m. CT-arteriography (CTA) was used to diagnosis all feeding arteries of advanced cancers before infusing CDDP. Twenty-three of 26 cases with orbital invasion were treated with preservation of the eyeball. In three cases with extirpation of the eyeball CTA was not used in the treatment, and CDDP was infused into only the maxillary artery excluding the transverse facial artery. In skullbase invasion cases, the number of complete responses (CR) was 8/14, and that of partial responses (PR) was 6/14. Feeding arteries originating from the external carotid artery were found in 10 of all 14 cases by CTA, and four cases in which blood supply was from both carotid arteries were all anterior skullbase invasion cases. Ten cases with superselective intra-arterial chemotherapy originating from only the external carotid artery were significantly better responders than four cases originating from both carotid arteries. In N3 cases, feeding arteries were found in more than three arteries by CTA and the overall survival rate was 55%, calculated by the Kaplan-Meier method. CTA is a very efficient method for diagnosing all feeding arteries of advanced cancers in the superselective intra-arterial chemotherapy.     

Curative and organ-preserving treatment with intra-arterial carboplatin induction followed by surgery and/or radiotherapy for advanced head and neck cancer: single-center five-year results

Background  

This study evaluated the feasibility, toxicity, response rate and survival of neoadjuvant superselective intra-arterial infusion of high dose carboplatin in advanced head and neck cancer.     

Impact of intra-arterial chemotherapy including internal carotid artery for advanced paranasal sinus cancers involving the skull base

Background:

The most significant problem of intra-arterial chemotherapy for advanced paranasal sinus carcinomas and residual cancers supplied by internal carotid artery (ICA) and involving the skull base is the lack of salvage therapies.

Objective:

The objective of the study was to evaluate the usefulness of intra-arterial chemotherapy including ICA infusion for treating advanced paranasal sinus carcinomas, which have invaded the skull base.

Methods:

Forty-six patients with advanced paranasal sinus carcinomas supplied by ICA were treated by intra-arterial chemotherapy using CDDP and sodium thiosulphate (STS) as a neutraliser of CDDP toxicity. After evaluating CT angiography, 150 mg m⁻² of CDDP was superselectively administered weekly to each feeding artery including ICA four times.

Results:

The 10-year overall survival rate and progression-free survival rate were 70.7 and 60.2%, respectively. Compared with control group without infusing ICA, recurrences at anterior skullbase or anterior ethomoid sinus were significantly diminished. Of 32 patients in which the orbital apex had been invaded, 29 patients were treated with successful preservation of orbital contents. The CT angiography could efficiently determine all feeding arteries supplying the cancers. Consequently, chemotherapy could be administered on schedule, and side effects were minimal and acceptable.

Conclusions:

This new method has promising applications in the treatment of advanced paranasal sinus carcinomas involving the skull base.     

Intra-arterial chemoradiotherapy for locally advanced oral cavity cancer: analysis of therapeutic results in 134 cases

The objective of this study was to investigate the therapeutic results of arterial injection therapy via the superficial temporal artery for 134 cases of stages III and IV (M0) oral cavity cancer retrospectively, and to clarify the prognostic factors. We administered intra-arterial chemoradiotherapy by continuous infusion of carboplatin in 65 cases from January 1993 to July 2002. Systemic chemotherapy was performed on 26 cases at the same time. We administered intra-arterial chemoradiotherapy by cisplatin with sodium thiosulphate in 69 cases from October 2002 to December 2006. Systemic chemotherapy was performed on 48 cases at the same time. The 3-year local control rate was 68.6% (T2-3: 77.9%; T4: 51.3%), and the 3-year survival rate was 53.9% (stage III: 62.9%; stage IV: 45.3%). Regarding the results of multivariate analysis of survival rates, age (<65), selective intra-arterial infusion, and the use of cisplatin as an agent for intra-arterial infusion were significant factors. The therapeutic results of intra-arterial chemoradiotherapy via the superficial temporal artery were not inferior to the results of surgery. In particular, the results of arterial injection therapy by cisplatin with sodium thiosulphate were excellent, so we believe that it will be a new therapy for advanced oral cavity cancer.     

Proton Beam Therapy and Continuous Intra-Arterial Chemotherapy for Polymorphous Low-Grade Adenocarcinoma in the Hard Palate

Polymorphous low-grade adenocarcinoma is a rare malignant tumor that mainly occurs in salivary glands, particularly in the hard palate. To date, surgery has been the most commonly used treatment method with the aim of achieving negative margins of resection. Here, we report a case of a 51-year-old woman who presented with a painless growing mass in her oral cavity with Rouviere''s lymph node metastasis. Laboratory data showed severe anemia because of bleeding from the tumor. We inserted two catheters into the bilateral external carotid arteries via the superficial temporal arteries, and began continuous intra-arterial infusion with cisplatin and a cisplatin-neutralizing agent. The bleeding stopped after the first infusion, and we continued with weekly arterial cisplatin infusion and proton beam therapy (70.4 GyE in 32 fractions). A decrease in tumor volume has been maintained for 2 years, with no evidence of new metastasis.Key Words: Polymorphous low-grade adenocarcinoma, Proton beam therapy, Continuous intra-arterial chemotherapy     

Excision of head and neck tumors combined with carotid artery resection without arterial blood vessel reconstruction

OBJECTIVE To summarize our clinical experience in treating 31 patients with neck masses undergoing carotid artery resection without arterial anastomosis （vascular reconstruction） in Tianjin Cancer Hospital during a period from 1979 to 2002. METHODS Preoperatively, patients were instructed to apply pressure to the carotid artery. Tumor excision combined with carotid artery resection （TECCAR） was conducted after an accurate testing of valid cerebral blood supply and compensation. RESULTS Among the study patients, 17 were male and 14 female, with the age ranging from 14 to 58 years. Of the 31 cases, 23 were carotid body tumors （8 malignant）, 2 vagal body tumors （1 malignant）, 4 carotid aneurysms, and 2 were metastatic tumors from the cervix involving carotid artery. Of the patients, a subtotal resection of the head and neck masses was conducted in 22 cases. Intraoperative death did not cerebrovascular complications occur, and postoperative CNS or （CVC） were not found. CONCLUSION TECCAR without arterial anastomosis is a safe and feasible procedure. In addition, this method of surgery has more advantages in comparison to an arterial anastomosis： i） Tumor resection was more complete, ii） Complications such as thrombus, infection, and lethal hemorrhage etc., were rare after surgery; iii） Postoperative radiotherapy, if needed, would be safe and acceptable; iv） It was a more simplified operational procedure.     

口腔癌持续性动脉灌注新辅助化疗的疗效观察

  目的  观察区域性持续动脉灌注新辅助化疗对口腔癌的疗效及不良反应。  方法  53例口腔癌患者经颞浅动脉逆行插管, 微量注射泵持续动脉灌注卡铂、5-Fu。观察化疗前、后原发肿瘤灶和颈淋巴结大小, 评估化疗后标本的病理学分级, 记录化疗的主要不良反应。  结果  前3次化疗的完全缓解率分别为:58.49%、76.60%和84.62%;化疗后分级中, Ⅲ+Ⅳ级的百分比分别为:33.33%、61.90%和80.77%;部分淋巴结出现不同程度的缩小; 不良反应轻微。  结论  经颞浅动脉插管持续灌注化疗的完全缓解率高, 且多次化疗的疗效优于单次化疗; 有利于对原发灶的完全切除。      

Preparation and drug release characteristics of pingyangmycin gelatin microspheres for embolization therapy

The incidence of head and neck tumors is nearly 10% of the total incidence of malignant tumors in ourcountry[1]. For a long time the therapy of the head and neck tumors mainly depends on the surgery operations. The blood supply in oral and maxillofacial region isflourish and the anatomic structure is complicated, so the conventional surgery has some problems, such as high risk, heavy trauma, high relapse rate, et al., and thefeatures deformation and malfunction after operationhave bad effects…     

Clinical efficacy of local targeted chemotherapy for triple-negative breast cancer

Background

The aim of the study was to evaluate the clinical efficacy of superselective intra-arterial targeted neo-adjuvant chemotherapy in the treatment of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and human epidermal growth factor receptor 2 (HER2)-negative (triple-negative) breast cancer.

Patients and methods.

A total of 47 triple-negative breast cancer patients (29 at stage II, 13 at stage III and 5 at stage IV) were randomly assigned to two groups: targeted chemotherapy group (n=24) and control group (n=23). Patients in the targeted chemotherapy group received preoperative superselective intra-arterial chemotherapy with CEF regimen (C: cyclophosphamide [600 mg/m²]; E: epirubicin [90 mg/m²]; F: 5-fluorouracil [600 mg/m²]), and those in the control group received routine neoadjuvant chemotherapy with CEF. The duration of the treatment, changes in lesions and the prognosis were determined.

Results

The average course of the treatment was 15 days in the targeted chemotherapy group which was significantly shorter than that in the control group (31 days) (P<0.01). The remission rate of lesions was 91.6% in the targeted chemotherapy group and 60.9% in the control group, respectively. Among these patients, 9 died within two years, including 2 (both at IV stage) in the targeted chemotherapy group and 7 (2 at stage II, 4 at stage III and 1 at stage IV) in the control group.

Conclusions

As an neoadjuvant therapy, the superselective intra-arterial chemotherapy is effective for triple-negative breast cancer, with advantages of the short treatment course and favourable remission rates as well as prognoses.     

经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效分析

目的 观察经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效和毒副反应。方法16例无法切除局部晚期上颌恶性肿瘤患者,行选择性颞浅动脉插管后,根据化疗方案用微量输液泵经导管远心端药池输注相应化疗药物：多西他赛60～75mg／m2匀速灌注2h,d1;顺铂75mg／m2大剂量冲击2h,d1;氟尿嘧啶500mg／m2连续灌注120h,d1～d5;吡柔比星25mg／m2匀速灌注2h,d1～d3;吉西他滨1000mg／m2连续滴注30min,d1、d8。21天为1个周期,2个周期分别采用RECIST 1.1标准和NCI CTC 3.0标准评价近期疗效和毒副反应并随访远期生存情况。结果16例均可评价近期疗效,其中CR 1例,PR 10例,SD 5例,RR为68.8％,DCR为100.0％。14例获随访（87.5％）,中位生存期和无进展生存期分别为26.0个月和4.0个月。全组未有4级毒副反应发生,无治疗相关性死亡,3级毒副反应主要为1例耳廓部分坏死、3例贫血及1例骨髓抑制,其余均为1～2级。结论 无法切除的晚期上颌恶性肿瘤经动脉灌注化疗后能够取得较为满意的治疗效果,毒副反应可耐受。     

Recurrent angiosarcoma effectively treated with superselective continuous intra-arterial injection of recombinant interleukin-2 combined with radiotherapy

We report a case of recurrent angiosarcoma (AS) in a 63-year-old man, effectively treated with a superselective continuous intra-arterial injection of recombinant interleukin-2 (rIL-2) combined with electron beam radiotherapy. The patient, who had undergone surgical resection for AS on his face near the nasal bridge, was admitted to our hospital because of recurrent AS on his bilateral cheeks. We placed 4-French catheters in the right external carotid artery (ECA) and superselectively in the left facial artery. A continuous intra-arterial injection of rIL-2 was administered in combination with radiotherapy using a 6 MeV electron beam. The lesion rapidly decreased in size. The total dose of rIL-2 was 3.72 × 10⁷ IU (International Unit) in the right ECA and 2.96 × 10⁷ IU in the left facial artery, while the total radiation dose was 50 Gy, in 25 fractions, for the tumor on the right cheek and 46 Gy, in 23 fractions, for the erythematous plaque on the left cheek. The patient was discharged with almost no cutaneous lesion on his cheeks. Unfortunately, there was another recurrence of AS and the patient died of respiratory failure due to lung metastases. However, as the lesion could be completely controlled even for a while, we believe this treatment method will contribute to the future management of AS.     

An anatomical study of the arteries for intraarterial chemotherapy of head and neck cancer

Background. The intraarterial approach is one of the most important routes for the administration of anticancer drugs for head and neck cancer. A profound knowledge of the anatomical characteristics and variations of the carotid artery, such as its branching pattern, length, and inner diameter, is essential to avoid complications with catheter insertion. Methods. We conducted a morphometric investigation of head and neck arteries in 29 Japanese cadavers (58 sites). Results. The branching pattern of the external carotid artery showed variations. In 65.5% of the cadavers, the lingual, facial, and superior thyroid arteries arose separately. However, in 31.0% of the cadavers, the lingual artery formed a common trunk with the facial artery, and in 3.5%, the lingual artery formed a common trunk with the superior thyroid artery. The transverse facial artery arose from the superficial temporal artery in 53.4% of the specimens, from the maxillary artery in 27.6%, and from a site central to the maxillary artery in 19.0%. The posterior auricular artery arose from the external carotid artery at the same level as the maxillary artery in 37.9% of specimens, and from a site central to the maxillary artery in 62.1%. The occipital artery arose from the external carotid artery at the same level as the maxillary artery in 55.2% of specimens, and from a site peripheral to the facial artery in 44.8%. The lengths from the auricular point to the origins of the upper branches of the external carotid artery were: 2.8 mm to the transverse facial artery, 3.2 cm to the maxillary artery, 3.8 cm to the posterior auricular artery, 6.6 cm to the occipital artery, 7.4 cm to the facial artery, 8.8 cm to the lingual artery, and 10.4 cm to the superior thyroid artery. Conclusions. These results, have led to some clarification of the clinicoanatomical basis for intraarterial infusion. These data should be helpful for assessing the approximate level of the catheter tip and for evaluating whether the catheter is placed appropriately, by transient staining of the infused area. Received: February 12, 1999 / Accepted: July 28, 1999     

Intimal–medial thickness and carotid arteries lumen in irradiated patients for head and neck cancer: preliminary data of an observational study

Objectives

To investigate the effect of external beam radiotherapy (EBRT) for head and neck cancer (HNC) the intimal–medial thickness (IMT) and the lumen of the carotid artery.

Methods

Patients with HNC and an indication for EBRT were enrolled. A carotid artery color Doppler examination was performed before and 6 and 12 months after EBRT.

Results

From 2008 to 2011, 50 patients were enrolled. The mean carotid IMT was 0.9 vs. 1.02 mm before and 6 months after EBRT, respectively (p = 0.0001). The common carotid artery lumen was narrowed without statistical significance, 6 months after EBRT (p = 0.3). 1 year from EBRT, the IMT increase and the lumen reduction were statistically significant (p = 0.001, p = 0.01, respectively). Neurological events (stroke or TIA) were not observed.

Conclusions

Our data showed a significant IMT increase 6 months from EBRT without a corresponding narrowing of the common carotid lumen while a significant increase 12 months after EBRT.     

Lateral temporal bone resection for malignancy of external auditory meatus: our approach

Objective

Surgical management of tumors of the external ear remains controversial with regard to the extent of resection and the efficacy of piecemeal resection compared to standard en bloc resection. The objective was to study the results of lateral temporal bone resection with soft tissue resection used at our centre in managing a series of such cases.

Setting

Tertiary referral centre

Patients

A retrospective study was carried out on seven cases of temporal bone malignancies treated at our center, with lateral temporal bone resection by the otologic microsurgical technique and superficial parotidectomy, with adjuvant radiotherapy where indicated. The mode of presentation, clinical and pathological staging, extent of surgical resection, reconstructive methods used and adjuvant therapy given were evaluated. The disease free survival on follow-up was noted.

Results

Disease free survival achieved was comparable with other published series, with acceptable morbidity patterns.

Conclusion

Lateral temporal bone resection using otologic microsurgical technique with soft tissue resection is an effective way of achieving control of temporal bone malignancies.     

Radiation-induced carotid artery atherosclerosis

Purpose

Carotid arteries frequently receive significant doses of radiation as collateral structures in the treatment of malignant diseases. Vascular injury following treatment may result in carotid artery stenosis (CAS) and increased risk of stroke and transient ischaemic attack (TIA). This systematic review examines the effect of radiotherapy (RT) on the carotid arteries, looking at the incidence of stroke in patients receiving neck radiotherapy. In addition, we consider possible surrogate endpoints such as CAS and carotid intima-medial thickness (CIMT) and summarise the evidence for radiation-induced carotid atherosclerosis.

Materials and methods

From 853 references, 34 articles met the criteria for inclusion in this systematic review. These papers described 9 studies investigating the incidence of stroke/TIA in irradiated patients, 11 looking at CAS, and 14 examining CIMT.

Results

The majority of studies utilised suboptimally-matched controls for each endpoint. The relative risk of stroke in irradiated patients ranged from 1.12 in patients with breast cancer to 5.6 in patients treated for head and neck cancer. The prevalence of CAS was increased by 16–55%, with the more modest increase seen in a study using matched controls. CIMT was increased in irradiated carotid arteries by 18–40%. Only two matched-control studies demonstrated a significant increase in CIMT of 36% and 22% (p = 0.003 and <0.001, respectively). Early prospective data demonstrated a significant increase in CIMT in irradiated arteries at 1 and 2 years after RT (p < 0.001 and <0.01, respectively).

Conclusions

The incidence of stroke was significantly increased in patients receiving RT to the neck. There was a consistent difference in CAS and CIMT between irradiated and unirradiated carotid arteries. Future studies should optimise control groups.     

Selective internal iliac artery oxaliplatin infusion: Another facultative treatment to unremitting hematuria in stage T4 bladder carcinoma

Objective  

To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma.     

Study of Thyro-Lingual Trunk and its Clinical Relevance

Every surgery is planned on the anatomical arrangement of the structures. Any variation in the arterial arrangement may lead to haemorrhagic episodes during intraoperative procedures. In this study, variations in the branching pattern of external carotid artery were noted. In two of the cases, thyrolingual trunk was observed. In the first case, thyrolingual trunk was arising from the common carotid artery, 17 mm below carotid bifurcation and in the second one at the carotid bifurcation. The knowledge of anatomical variation is necessary during intra-arterial chemotherapy and to prevent haemorrhagic accidents during intraoperative procedures.