SUPERSELECTIVE INTRAARTERIAL INFUSION OF CISPLATIN FOR SQUAMOUS-CELL CARCINOMA OF THE MOUTH - PRELIMINARY CLINICAL-EXPERIENCE

OBJECTIVE. The purpose of this study was to assess the initial clinica l response to superselective intraarterial infusion of cisplatin for t reating stage III and stage IV squamous cell carcinoma of the mouth. S UBJECTS AND METHODS. Thirteen patients received intraarterial cisplati n therapy. The tumors were located in the tongue (n = 7), gingiva (n = 3), buccal mucosa (n = 1), hard palate (n = 1), and floor of the mout h (n = 1). A coaxial technique was used to place microcatheters in the lingual, facial, inferior alveolar, buccinator, and distal internal m axillary arteries, depending on tumor location. The feeding Vessels we re identified by staining the tumor with infusion of indigocarmine dye in the selected vessel. Relatively low-dose cisplatin (30-40 mg/m(2)) was injected at the rate of 50 mg/hr. Two or three injections were pe rformed, with a I-week interval between injections. After chemotherapy , eight patients underwent surgery, four had radiation therapy, and on e had both. RESULTS. Thirty-four intraarterial infusions were done suc cessfully without any complications. Arterial infusion of indigocarmin e dye was useful for exact identification of feeding vessels, especial ly when the tumor was extensive, at the margin of the arterial supply, or near the midline. The overall response rate was 92% (complete resp onse [tumor completely resolved], 38%; partial response [tumor reducti on greater than or equal to 50%], 54%). Ten of 13 patients had no recu rrence from 4 to 19 months (mean, 10 months) after treatment. Two pati ents died of metastatic diseases 6 months after surgery or radiation t herapy. One patient had local recurrence 8 months after surgery and po stoperative irradiation. No systemic toxicity such as renal failure, l iver dysfunction, or bone marrow suppression was observed. Mild and tr ansient local toxicity such as edema or mucositis of the infused area was relatively common. Trigeminal neuralgialike symptoms and reduced m outh opening occurred in two cases and one case, respectively, probabl y due to direct toxicity to the peripheral trigeminal nerve and mastic atory muscles, respectively. CONCLUSION. Superselective intraarterial infusion of low-dose cisplatin is feasible and safe and may have impor tant applications in treating advanced carcinoma of the mouth.