A combination therapy of continuous superselective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma - A phase I study

BACKGROUND. To improve the treatment result for locally advanced head and n eck carcinoma, the authors used a combination of radiotherapy with supersel ective continuous intraarterial therapy using carboplatin. The dose limitin g toxicity (DLT), maximum tolerated dose (MTD), and treatment effectiveness were tested in Phase I and II protocols. PATIENTS AND METHODS. Thirty-five patients were entered into the study from August 1992 to May 1997. The target arteries were the lingual artery in 18 cases, facial artery in 5 cases, maxillary artery in 11 cases, and externa l carotid artery initially changing to lingual artery in 1 case. Escalating daily carboplatin doses were tested, starting from 10 mg/m(2) (total dose, 360 or 400 mg/m(2)) to 15 mg/m(2) (total dose, 405 or 450 mg/m(2)) and the n 20 mg/m(2) (total dose, 460 or 500 mg/m(2)). Radiotherapy was administere d using a 6-megavolt linear accelerator to a total dose of 50-60 grays. Int erstitial radiotherapy boost also was used for carcinoma of the tongue. RESULTS. Excluding 3 patients who discontinued treatment, the treatment res ults of 32 patients were complete response in 21 cases, partial response in 10 cases, and no change in 1 case. Neutropenia was the DLT, and the MTD wa s 500 mg/m(2). The local control rate was 64%. CONCLUSIONS. Superselective continuous intraarterial carboplatin and concur rent radiation therapy can be delivered safely with good efficacy for local ly advanced carcinomas of the tongue and base of the tongue. Surgical treat ment of these diseases usually incurs severe functional loss. This current approach may be a breakthrough in these cancers. (C) 2000 American Cancer S ociety.