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Radiation and Intra-arterial Cisplatin
Effects on Arteries and Free Tissue Transfer
Joseph Valentino, MD;
Lisa Weinstein, MD;
Richard Rosenblum, MD;
William Regine, MD;
Michael Weinstein, MD
Arch Otolaryngol Head Neck Surg. 2000;126:215-219.
Objectives To determine the histopathologic effect of combined intra-arterial cisplatin administration and hyperfractionated external beam radiation treatment (HYPERRADPLAT) on potential recipient arteries in the neck and to analyze the efficacy of free tissue transfer (FTT) in patients undergoing HYPERRADPLAT.
Design Cisplatin-perfused and nonperfused artery segments were harvested during planned interval neck dissection performed 6 to 10 weeks after HYPERRADPLAT. These segments were evaluated by light microscopy and transmission electron microscopy. All patients undergoing FTT after HYPERRADPLAT were reviewed retrospectively.
Setting Academic medical center.
Patients and Intervention Eight patients undergoing HYPERRADPLAT for head and neck squamous cell carcinoma and planned interval neck dissection were prospectively studied. All patients had a perfused artery sampled, and 3 also had a nonperfused (control) artery sampled. Five patients undergoing FTT after HYPERRADPLAT were retrospectively analyzed for outcome of FTT.
Results No consistent histological or ultrastructural differences were detected between injected and noninjected arteries. Both demonstrated intimal thickening, collagen and elastin deposition in the intimal layer, and, occasionally, intimal smooth muscle proliferation. A smaller fraction of the injected and noninjected arteries demonstrated smooth muscle cell vacuolation, elastic fiber degeneration, and calcific deposits. Four of 5 FTTs in patients undergoing HYPERRADPLAT were successful.
Conclusions The changes seen in the injected and noninjected arteries were characteristic of ionizing radiation. Arteries treated with HYPERRADPLAT had no observable difference from vessels treated with radiation alone. These vessels can be used with caution as recipient vessels for FTT. Further clinical experience is needed to establish the expected results of FTT using these arteries.
From the Division of Otolaryngology–Head and Neck Surgery (Drs Valentino and Rosenblum) and the Departments of Pathology (Drs L. Weinstein and M. Weinstein) and Radiation Oncology (Dr Regine), University of Kentucky Chandler Medical Center; and the Department of Surgery, Veterans Affairs Medical Center (Dr Valentino), Lexington, Kentucky.
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