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Intra-arterial Supradose Cisplatin Chemotherapy and Concomitant Radiotherapy for Organ Preservation

Sandeep Samant, MD; K. Thomas Robbins, MD; Parvesh Kumar, MD; Jennie Z. Ma, PhD; Francisco Vieira, MD; Catherine Hanchett, BA

Arch Otolaryngol Head Neck Surg. 2001;127:1451-1456.

Background  Invasion of bony or cartilaginous structures by advanced upper aerodigestive tract cancer has been considered an indication for surgery on the basis of historic experience of poor responsiveness to radiation therapy. At University of Tennessee–Memphis, patients with advanced head and neck cancer have been treated on a protocol of concomitant intra-arterial (targeted) cisplatin and conventional radiation therapy.

Objective  To compare the efficacy, in terms of disease control and survival, of this protocol in patients with T4 squamous cell cancers and invasion of bony or cartilaginous structures (group 1; n = 45) vs those with T4 disease but no bone or cartilage involvement (group 2; n = 90).

Design  Subset analysis of protocol database and retrospective chart review.

Methods  Treatment consisted of 4 weekly intra-arterial infusions of cisplatin (150 mg/m² per week), with simultaneous systemic neutralization by intravenous sodium thiosulfate (9 mg/m²), and concurrent radiation therapy at 180 rad (1.8 Gy) or 200 rad (2 Gy) per fraction to a planned total of 6600 to 7400 rad (66-74 Gy) to the primary site or overt nodal disease. Presence of bone or cartilage invasion was established by review of tumor diagrams of clinical findings and computed tomography or magnetic resonance imaging reports.

Results  Of 135 patients who had T4 disease and a minimum follow-up of 9 months (median, 40 months), 45 had clinical or radiologic evidence of bone (n = 29: mandible, 12; maxilla, 9; sphenoid, 3; hyoid, 6) and/or cartilage (n = 18: thyroid, 16; cricoid, 4) invasion (some patients had involvement of more than 1 site). The rate of complete response in group 1 (66.7%) was not significantly different from that in group 2 (71.1%) (² test, P = .79). The 2-year overall actuarial survival for group 1 (46.3%; 95% confidence interval, 30.3%-62.3%) was not significantly different (generalized Wilcoxon test, P = .36) from that of group 2 (36.9%; 95% confidence interval, 25.5%-48.4%). A marked trend was noted for higher response rates in cases of cartilage invasion (81.2%) than in those with bone invasion (58.6%) (P = .15).

Conclusion  Equivalent efficacy of treatment in the 2 groups suggests that targeted chemoradiation can be a definitive therapeutic option in patients with advanced head and neck cancer invading bony or cartilaginous structures.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Samant and Vieira) and Preventive Medicine (Dr Ma), University of Tennessee Health Sciences Center, Memphis; Department of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Robbins and Ms Hanchett); and Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick (Dr Kumar).

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