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High-dose superselective intra-arterial cisplatin and concomitant radiation (radplat) for advanced head and neck cancer

Authors

  • Alfons J. M. Balm MD,

    1. Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
    2. Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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  • Coen R. N. Rasch MD,

    1. Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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  • Jan H. Schornagel MD,

    1. Department of Medical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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  • Frans J. M. Hilgers MD,

    1. Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
    2. Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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  • Ronald B. Keus MD,

    1. Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
    Current affiliation:
    1. Joint Centre for Radiation Oncology, Arnhem-Nijmegen, Rijnstate Hospital, Arnhem, The Netherlands
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  • Leo Schultze-Kool MD,

    1. Department of Interventional Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
    Current affiliation:
    1. St. Radboud Medical Center, Nijmegen, The Netherlands
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  • Annemieke H. Ackerstaff PhD,

    1. Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
    2. Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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  • Wim Busschers MSc,

    1. Department of Biometrics, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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  • I. Bing Tan MD

    1. Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
    2. Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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  • This study was presented at the fall meeting 2002 of The Netherlands Society of Otorhinolaryngology and Cervicofacial Surgery, Amsterdam, The Netherlands

Abstract

Background.

The purpose of this study was to study the effect of intensive targeted chemoradiation in a group of patients with head and neck cancer with stage IV inoperable disease.

Methods.

We examined 79 patients with inoperable stage IV head and neck cancer receiving intra-arterial infusion of high-dose cisplatin (150 mg/m2) on days 2, 9, 16, and 23 concomitant with delivery of external beam radiotherapy (total dose, 70 Gy; 2 Gy, 35 fractions; 1 fraction/day for 7 weeks). Sodium thiosulfate was administered intravenously to provide effective cisplatin neutralization.

Results.

Four patients were not assessable. Complete local tumor response was achieved in 72 patients (91%) and a partial response in three patients. The complete response rate of neck node metastases was 90%. The 1- and 2-year locoregional control rates were 82% and 69%, respectively. The median overall survival time was 2.2 years, with a 3-year overall survival probability of 43%. Acute toxicities were as follows: grade III/IV hematologic toxicity (22%/16%), grade III/IV nephrotoxicity (0%), grade III mucositis (43%), grade III skin reactions (24%), grade III toxicity of the upper gastrointestinal tract (57%), grade III nausea (20%), and grade III subjective hearing loss (10%). Grade V toxicity (treatment-related deaths) was 3.8%. Six (18%) of 33 patients with complete remission needed tube feeding 2 years after treatment without intercurrent salvage surgery.

Conclusions.

Supradose superselective intra-arterial cisplatin and concomitant radiation is an effective organ-preserving therapy in an unfavorable group of patients. Our series confirms encouraging results reported previously. This regimen is justified in unresectable patients despite the substantial toxicity. © 2004 Wiley Periodicals, Inc. Head Neck26: 485–493, 2004

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