High-dose intra-arterial chemotherapy in addition to hyperfractionated radiation is effective treatment for advanced head and neck cancer, according to a recent article published in the Journal of Clinical Oncology.
Head and neck cancer may occur in the tongue, mouth, salivary glands, pharynx, larynx, sinus and other sites located in the head and neck area. Treatment options may include surgery, radiation therapy, biological therapy and/or chemotherapy, depending on the specific type, location and stage (extent of disease at diagnosis) of the cancer. Locally advanced head and neck cancer refers to cancer that has spread from its site of origin to nearby sites in the body, including lymph nodes. Metastatic head and neck cancer refers to cancer that has spread to distant sites in the body, often including vital organs. Patients with head and neck cancer that has spread outside its original site or has recurred following initial therapy have suboptimal outcomes. Research efforts are focused on investigating novel therapeutic approaches to improve outcomes and minimize side effects for patients with this disease.
A relatively novel therapeutic approach for the treatment of head and neck cancer involves the administration of chemotherapy into a selected artery that delivers blood directly to the cancer (intra-arterial). Intra-arterial chemotherapy has shown promise in previous trials and is now being refined and evaluated in combination with other therapies. Intra-arterial administration augments anti-cancer effects of chemotherapy compared with systemic (full body) delivery through a few mechanisms: 1) the chemotherapy agent does not become diluted by mixing with the rest of the blood from the body prior to reaching the cancer, 2) the chemotherapy agent is not broken down in the body through biochemical processes prior to reaching the cancer, 3) larger amounts of the chemotherapy agent can reach the cancer with fewer associated systemic side effects.
In addition, hyperfractionated radiation has also demonstrated improved results over standard external radiation in the treatment of head and neck cancer. Hyperfractionated radiation involves lower doses of radiation administered more frequently, resulting in a higher total cumulative dose. Side effects from treatment with hyperfractionated radiation are less severe than those associated with higher doses that are administered at one time, thus allowing more patients to finish optimal treatment schedules.
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Researchers from the University of Kentucky recently conducted a clinical trial evaluating the combination of hyperfractionated radiation plus intra-arterial chemotherapy with cisplatin in patients with locally advanced head and neck cancer. Cisplatin is an effective chemotherapy agent when used alone in head and neck cancer and has also demonstrated properties which sensitize cancer cells to the effects of radiation. In this trial, 42 patients were treated with intra-arterial cisplatin prior to and during hyperfractionated radiation. Nearly 90% of patients experienced a complete disappearance of their cancer at the site of origin and 85% also experienced a complete disappearance of cancer in their lymph nodes. Two years following treatment, 73% of patients did not experience a local cancer recurrence and 57% of patients were alive. Approximately one-third of patients did not receive a second dose of intra-arterial cisplatin due to associated side effects. These patients had the same anti-cancer responses and survival outcomes as patients who had received both doses.
These results suggest that one-dose of intra-arterial cisplatin and hyperfractionated radiation therapy is effective treatment for locally advanced head and neck cancer, particularly when compared with other regimens utilized for this disease. Future clinical trials will evaluate different chemotherapy agents for intra-arterial infusion and/or this treatment regimen earlier in the course of the disease. Patients with head and neck cancer may wish to speak with their physician about the risks and benefits of intra-arterial cisplatin and hyperfractionated radiation therapy or the participation in a clinical trial further evaluating this regimen.
(Journal of Clinical Oncology, Vol 19, No 14, pp 3333-3339, 2001)