Adorján F Kovács1. 1. Department of Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Klinik für Kiefer und Plastische Gesichtschirurgie, D-60590 Frankfurt am Main, Germany. A.Kovacs@em.uni-frankfurt.de
Abstract
BACKGROUND: Patients with head and neck cancer and good pathologic response to neoadjuvant systemic induction chemotherapy have a better prognosis for survival than do those with stable or progressive disease. Thus, induction chemotherapy could theoretically help in stratifying further treatment, but toxicity is much too high. The prognostic implication of superselective intraarterial high-dose cisplatin administered by a femoral approach, which has much less toxicity, is not yet known. METHODS: One hundred eighty-seven unselected consecutive patients with previously untreated oral and oropharyngeal squamous cell carcinoma received intraarterial high-dose cisplatin for induction and were assessed for response by visual examination and palpation. This treatment was followed by surgery and adjuvant radiation with concomitant systemic chemotherapy. Omission of a modality depended on individual contraindications and not on preselection. The consequence of omissions has been the constitution of several treatment arms. The overall and disease-free survival in relation to clinical local response after intraarterial induction chemotherapy was calculated using the Kaplan-Meier method. Additional analysis excluded bias caused by stages and treatment arms. RESULTS: Explorative statistics using the log-rank and chi-square tests demonstrated a strong prognostic relevance of response to intraarterial chemotherapy irrespective of stage and treatment. CONCLUSIONS: Our results are encouraging for prospective randomized studies and molecular genetic investigations with intraarterial chemotherapy.
BACKGROUND:Patients with head and neck cancer and good pathologic response to neoadjuvant systemic induction chemotherapy have a better prognosis for survival than do those with stable or progressive disease. Thus, induction chemotherapy could theoretically help in stratifying further treatment, but toxicity is much too high. The prognostic implication of superselective intraarterial high-dose cisplatin administered by a femoral approach, which has much less toxicity, is not yet known. METHODS: One hundred eighty-seven unselected consecutive patients with previously untreated oral and oropharyngeal squamous cell carcinoma received intraarterial high-dose cisplatin for induction and were assessed for response by visual examination and palpation. This treatment was followed by surgery and adjuvant radiation with concomitant systemic chemotherapy. Omission of a modality depended on individual contraindications and not on preselection. The consequence of omissions has been the constitution of several treatment arms. The overall and disease-free survival in relation to clinical local response after intraarterial induction chemotherapy was calculated using the Kaplan-Meier method. Additional analysis excluded bias caused by stages and treatment arms. RESULTS: Explorative statistics using the log-rank and chi-square tests demonstrated a strong prognostic relevance of response to intraarterial chemotherapy irrespective of stage and treatment. CONCLUSIONS: Our results are encouraging for prospective randomized studies and molecular genetic investigations with intraarterial chemotherapy.
Authors: Missak Haigentz; Jan B Vermorken; Arlene A Forastiere; June Corry; Jonathan J Beitler; Primož Strojan; Dana M Hartl; Juan P Rodrigo; Carol R Bradford; Alessandra Rinaldo; Robert P Takes; William M Mendenhall; Ashok R Shaha; Gregory T Wolf; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2014-02-14 Impact factor: 2.503