Clinical Evaluation of Thermochemoradiotherapy Using Retrograde Superselective Intra-Arterial Infusion for Advanced Oral Cancer With Cervical Lymph Node Metastases

Iida, Masaki

Clinical Evaluation of Thermochemoradiotherapy Using Retrograde Superselective Intra-Arterial Infusion for Advanced Oral Cancer With Cervical Lymph Node Metastases

Masaki Iida DDS, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Kenji Mitsudo DDS, PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Yoshihito Ohara DDS, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Takashi Ohya DDS, PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Toshiyuki Koizumi DDS, PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Hideyuki Nakashima DDS, PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Toshinori Iwai DDS, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Senri Oguri DDS , PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Mitomu Kioi DDS, PhD, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Makoto Hirota DDS, PhD, Laboratory for Bone and Implant Sciences, Advanced prosthodontics, Weintraub center for reconstructive biotechnology, University of California - Los Angeles, School of Dentistry, Los Angeles, CA

Iwai Tohnai D.D.S., Ph.D., Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Patients of oral squamous cell carcinoma with bulky or multiple cervical lymph node metastases have a poor prognosis. Our strategy for patients with cervical lymph node metastases is to use the thermochemoradiotherapy using superselective intra-arterial infusion via the superficial temporal and occipital arteries. This study was to evaluate the therapeutic results and histopathological effects of thermochemoradiotherapy.

Twenty-five patients with cervical lymph node metastases of oral squamous cell carcinoma underwent thermochemoradiotherapy using superselective intra-arterial infusion with docetaxel and cisplatin. Treatment consisted of hyperthermia (3-8 sessions), superselective intra-arterial infusions (docetaxel, total 40-60 mg/m², cisplatin, total 100-150 mg/m²) and daily concurrent radiotherapy (total 40-60 Gy) for 4-6 weeks. Radical neck dissection was performed 5-8 weeks after the end of treatment. Residual primary tumor was present after treatment, surgery both primary lesion and neck disease was performed.

Eight of those 25 patients underwent surgery both primary lesion and neck disease. The other 17 patients underwent only neck dissection due to pathological complete response (CR) at primary lesion. In 16 of those 25 patients, hyperthermia-targeted metastatic lymph nodes were diagnosed as pathological CR (64%). In the remaining 9 patients, pathological diagnoses were partial response (PR) (36%). During follow-up, 17 patients were alive without disease, 1 patient was alive with regional relapse, 6 patients died due to pulmonary metastasis and 1 patients died due to other disease. Overall survival and locoregional control rates (range, 6-75 months) were 71.4% and 88.6%, respectively.

Thermochemoradiotherapy using retrograde superselective intra-arterial infusion provided good survival and locoregional control rates in advanced oral cancer.

Mitsudo K, Koizumi T, Iida M, et al.:Thermochemoradiation therapy using superselective intra-arterial infusion via superficial temporal and occipital arteries for oral cancer with N3 cervical lymph node metastases. Int J Radiat Oncol Biol Phys, 2012 1;83(5):e639-45.
Mitsudo K, Koizumi T, Iida M, et al.:Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: Analysis of therapeutic results in 112 cases. Radiother Oncol. in press