Complications associated with selective high-dose intraarterial cisplatin and concomitant radiation therapy for advanced head and neck cancer

PURPOSE: To describe the incidence and severity of complications associated with intraarterial cisplatin and concomitant radiation therapy for advanced head and neck cancer. MATERIALS AND METHODS: One hundred five patients treated between June 1993 and March 1998 were studied. Forty-seven (44%) had T4 lesions and 40 (37%) had bulky (N2/3) nodal disease. Three hundred eighty-five procedures were performed. All patients were treated with selective intraarterial tumor-directed cisplatin (150 mg/m(2) weekly x 4), simultaneous intravenous thiosulfate (9 g/m(2)) for systemic neutralization of cisplatin, and conventional external-beam radiation to the primary tumor and nodal disease (total dose of 66-74 Gy). RESULTS: One hundred five patients were evaluated for complications. Twenty-two (5.7%) groin hematomas occurred, none of which needed therapy. Two asymptomatic common carotid artery dissections were reported. Two patients experienced acute occlusion of the external iliac artery requiring a femorofemoral bypass. Overall, there were 41 grade III/IV chemotoxic events related to treatment. Chemotoxic events included 29 mucosal events, nine hematologic events, two otologic events, and one gastrointestinal event. No renal events occurred. There were three permanent and three transient neurologic events. CONCLUSION: Selective high-dose intraarterial cisplatin and concomitant radiation therapy for advanced head and neck cancer can be performed safely with a relatively low complication rate compared to standard intravenous chemotherapy treatment protocols.