A TARGETED SUPRADOSE CISPLATIN CHEMORADIATION PROTOCOL FOR ADVANCED HEAD AND NECK-CANCER

BACKGROUND: Hypothesizing that cisplatin (DDP) drug resistance is dose dependent and the radiosensitizing effect of DDP is clinically benefi cial, we conducted a chemoradiation protocol using extremely high dose s of DDP delivered intra-arterially (IA) to locally advanced head and neck tumors. PATIENTS AND METHODS: Twenty-nine patients with untreated stage ni disease received 4 weekly infusions of 150 mg/m(2), simultan eous systemic DDP neutralization with intravenous (IV) bolus sodium th iosulfate, and concomitant radiotherapy (180 to 200 cGy/day X 35 fract ions). RESULTS: The complete response rate of the 24 evaluable patient s as determined with repeat biopsies was 23/24 (96%). Of the 29 patien ts evaluable for toxicity, central nervous system complications relate d to the infusion technique occurred with 2/110 infusions, both of whi ch were reversible. The rate of grade III to IV chemotoxicity Tvas 13% . The median length of follow-up was 22 months. There have been 6 recu rrences: 1 local; 3 regional; and 2 at distant sites. The projected ov erall and disease-free 3-year survival was 88% and 53%, respectively. CONCLUSION: We conclude that the combination of rapid selective delive ry of supradose DDP/IV thiosulfate neutralization and concomitant radi otherapy can be safely and effectively applied to patients with advanc ed head and neck cancer. Preliminary survival analysis indicates that this approach may improve the prognosis for patients with an otherwise devastating disease.