TARGETED INFUSIONS OF SUPRADOSE CISPLATIN WITH SYSTEMIC NEUTRALIZATION FOR CARCINOMAS INVADING THE TEMPORAL BONE

In an attempt to improve the dismal prognosis for patients with advanc ed cancer involving the temporal bone, a regional chemotherapy techniq ue was piloted as part of the multimodality therapy for such patients, Rapid supradose cisplatin infusions selectively delivered to the lesi on were given to 14 patients with carcinoma involving the temporal bon e. Concurrent systemic cisplatin neutralization was achieved with sodi um thiosulfate which permitted the use of cisplatin dose intensity reg imens equivalent to fivefold the conventional amount. Four patients re ceived chemotherapy alone, four had concomitant irradiation, and six h ad subsequent irradiation and/or temporal bone surgery. All patients t olerated the chemotherapy without significant complications or toxicit y. All three of the patients with previously untreated disease respond ed to chemotherapy (2 CRs, 1 PR); three of the seven patients with rec urrent disease responded to chemotherapy; and all four patients treate d with chemoradiation had a complete response (including one patient w ith recurrent disease). The median follow-up time was 19 months (range , 5 to 63 months). Nine of the 14 patients are alive, including the 4 who were treated with targeted chemoradiation. The use of targeted hig h-dose chemotherapy for patients with malignant skull base lesions off ers hope for improved outcome, particularly when this regimen is given simultaneously with radiation.