High-dose intra-arterial cisplatin therapy followed by radiation therapy for advanced squamous cell carcinoma of the head and neck

Objective: To assess the effectiveness of a protocol consisting of 4 cycles of high-dose intra-arterial cisplatin infusions followed by radiation ther apy for improving chemotherapy response rates, organ preservation, and surv ival in patients with advanced-stage untreated and previously treated squam ous cell carcinoma of the head and neck. Design and Setting: A prospective study of sequentially enrolled patients t reated in an academic medical center. The Kaplan-Meier method was used for survival analysis. Patients: Fifty-eight nonpregnant adults, 18 years of age or older, with me asurable untreated or recurrent advanced biopsy-proven squamous cell carcin oma of the head and neck. Main Outcome Measures: Response rate to targeted intra-arterial cisplatin i nfusions, organ preservation, and survival. Results: Fifty-eight patients (44 men and 14 women) were followed up for at least 2 years (median duration of follow-up, 27 months). Twenty-nine (67%) of the 43 previously untreated patients had a complete response to intra-a rterial cisplatin therapy. Of the untreated patients, 28 are alive and dise ase free after a median follow-up time of 30 months. Five of the patients w ith recurrent disease had a complete response to intraarterial cisplatin th erapy. There were 4 survivors after a median follow-up time of 17.5 months. Of note, there were no deaths or serious complications related to the trea tment in either group. Conclusions: High-dose intra-arterial cisplatin therapy provides a high com plete and partial response rate (91%). The combination of high-dose intra-a rterial cisplatin and radiation therapy is effective in improving survival and organ preservation rates in patients with previously untreated, advance d squamous cell carcinoma of the head and neck. This treatment protocol is much less effective for recurrent disease.