Induction chemotherapy by superselective intra-arterial high-dose carboplatin infusion for head and neck cancer

To evaluate the feasibility, maximum dose of drug tolerated, technical prob lems, systemic and local toxicity, response rate, overall and disease-free survival, we studied superselective intra-arterial infusion of high-dose ca rboplatin as part of a multimodality treatment for head and neck cancer. Fo rty patients with untreated stage II-IV head and neck squamous cell carcino mas received induction chemotherapy with high-dose carboplatin (three cycle s at 2-week intervals using 300-350 mg/m(2) per cycle), delivered via super selective transfemoral angiography followed by radiotherapy or surgery plus radiotherapy, No technical complications occurred during or after the infu sion. Systemic toxicity was minimal, and local toxicity was moderate. At th e end of chemotherapy the overall complete and partial response rate was 90 % (36/40) at the primary site and 64% (16/25) at the neck nodes. The median follow-up was 24.4 months (range 3-52). To date 21 patients are alive with out disease, 2 are alive with disease, 13 have died of disease, and 4 have developed a metachronous lung tumor. There was a good correlation between t he response to chemotherapy and disease-free survival, No statistically sig nificant benefit in survival was observed with respect to other series of h ead and neck tumors treated with different protocols. However, discriminati ng between responding and nonresponding patients, this procedure can have a prognostic significance in planning integrated treatments for these types of tumors.