Thermochemoradiation Therapy Using Superselective Intra-arterial Infusion via Superficial Temporal and Occipital Arteries for Oral Cancer With N3 Cervical Lymph Node Metastases

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• 作者：Kenji Mitsudo ; Toshiyuki Koizumi ; Masaki Iida ; Toshinori Iwai ; Senri Oguri ; Noriyuki Yamamoto ; Yoshiyuki Itoh ; Mitomu Kioi ; Makoto Hirota ; Iwai Tohnai
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 August, 2012
• 年：2012
• 卷：83
• 期：5
• 页码：e639-e645
• 全文大小：344 K

文摘

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Purpose

To evaluate the therapeutic results and histopathological effects of treatment with thermochemoradiation therapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries for N3 cervical lymph node metastases of advanced oral cancer.

Methods and Materials

Between April 2005 and September 2010, 9 patients with N3 cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiation therapy using superselective intra-arterial infusion with docetaxel (DOC) and cisplatin (CDDP). Treatment consisted of hyperthermia (2-8 sessions), superselective intra-arterial infusions (DOC, total 40-60 mg/m²; CDDP, total 100-150 mg/m²) and daily concurrent radiation therapy (total, 40-60 Gy) for 4-6 weeks.

Results

Six of 9 patients underwent neck dissection 5-8 weeks after treatment. In four of these 6 patients, all metastatic lymph nodes, including those at N3, were grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) tumors, as classified by the system by Shimosato et?al (Shimosato et?al Jpn J Clin Oncol 1971;1:19-35). In 2 of these 6 patients, the metastatic lymph nodes were grade 2b (destruction of tumor structures with a small amount of residual viable tumor cells). The other 3 patients did not undergo neck dissection due to distant metastasis after completion of thermochemoradiation therapy (n=2) and refusal (n=1). The patient who refused neck dissection underwent biopsy of the N3 lymph node and primary sites and showed grade 3 cancer. During follow-up, 5 patients were alive without disease, and 4 patients died due to pulmonary metastasis (n=3) and noncancer-related causes (n=1). Five-year survival and locoregional control rates were 51 % and 88 % , respectively.

Conclusions

Thermochemoradiation therapy using intra-arterial infusion provided good histopathologic effects and locoregional control rates in patients with N3 metastatic lymph nodes. However, patients with N3 metastatic lymph nodes experienced a high rate of distant metastases.