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Concurrent intra-arterial carboplatin administration and radiation therapy for the treatment of advanced head and neck squamous cell carcinoma: short term results.

Bertino G, Occhini A, Falco CE, Porta C, Corbella F, Colombo S, Balcet V, Morbini P, Zappoli F, Azzaretti A, Rodolico G, Tinelli C, Benazzo M - BMC Cancer (2009)

Bottom Line: The aim of the present study was to evaluate the survival, efficacy and safety of a modified RADPLAT-like protocol using carboplatin instead of cisplatin.Forty-four (98%) of the 45 patients who completed the protocol and 10 (91%) of the 11 who did not, were free of disease at the end of the treatment, for a comprehensive 96% of CR overall.Haematological and non-haematological toxicities are virtually similar, but carboplatin has the advantage in that it is not nephrotoxic and can be used at very high doses without any significant increase in the extent of side effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico S, Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy. giulia.bertino@tin.it

ABSTRACT

Background: The aim of the present study was to evaluate the survival, efficacy and safety of a modified RADPLAT-like protocol using carboplatin instead of cisplatin.

Methods: Fifty-six patients with primary head and neck squamous cell carcinoma received 4 cycles of intra-arterial carboplatin (350 mg/m2 per cycle every 2 weeks), with concurrent three-dimensional conformal radiation therapy.

Results: Two major and 4 minor complications were observed. Forty-five of the 56 patients (80%) completed the protocol, while 11 (20%) patients had to discontinue the intra-arterial infusions due to the occurrence of severe haematological toxicity, but were able to complete radiotherapy. Forty-four (98%) of the 45 patients who completed the protocol and 10 (91%) of the 11 who did not, were free of disease at the end of the treatment, for a comprehensive 96% of CR overall. After a median 23.55 months (range: 2 to 58 months) of follow-up, 40 patients (71%) are alive and disease-free, 1 (2%) is alive but affected by disease and 15 (27%) have died of the disease or other causes.

Conclusion: Intra-arterial carboplatin administration with concurrent three-dimensional conformal radiation therapy seems to be a promising alternative to RADPLAT in the treatment of advanced head and neck tumours. Haematological and non-haematological toxicities are virtually similar, but carboplatin has the advantage in that it is not nephrotoxic and can be used at very high doses without any significant increase in the extent of side effects.

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Related in: MedlinePlus

Timing of the treatment protocol. SS = Saturday, Sunday; RT = radiotherapy; IAC = intra-arterial chemotherapy.
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Figure 1: Timing of the treatment protocol. SS = Saturday, Sunday; RT = radiotherapy; IAC = intra-arterial chemotherapy.

Mentions: Figure 1 summarizes the timing of the treatment protocol. The planned dose of carboplatin per cycle was 350 mg/m2 with a maximum amount of 1,4 g/m2 given in 4 cycles, every 2 weeks. No pharmacokynetic analyses were performed to select the dose of the drug, but it was chosen according to our previous experience of induction intra-arterial chemotherapy [15]. Carboplatin was administered intra-arterially (i.a.), dissolved in 80 mL of 0,9% saline and infused over 15-20 min by a battery-operated pump (Medrad Mark 5 Plus) with an infusion velocity of 4-6 mL/min. An angiographic catheter (Glidecath Radicofocus 5F Terumo) was introduced percutaneously under local anesthesia (10 mL of 2% lidocaine solution) into the common femoral artery, according to the Seldinger technique. The catheter tip was placed in the external carotid artery, under radiographic control. Diagnostic transfemoral carotid arteriography was performed and the most suitable branch of the artery, providing the main blood supply to the tumour, was selectively catheterised. The catheter was removed immediately after the infusion. A simultaneous intravenous (i.v.) infusion of 250 mL of 0,9% saline was administered. Dexamethasone (4 mg) and ondansetron (1 g) dissolved in 100 mL of 0,9% saline were administered i.v. 1 hour before the infusion.


Concurrent intra-arterial carboplatin administration and radiation therapy for the treatment of advanced head and neck squamous cell carcinoma: short term results.

Bertino G, Occhini A, Falco CE, Porta C, Corbella F, Colombo S, Balcet V, Morbini P, Zappoli F, Azzaretti A, Rodolico G, Tinelli C, Benazzo M - BMC Cancer (2009)

Timing of the treatment protocol. SS = Saturday, Sunday; RT = radiotherapy; IAC = intra-arterial chemotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749058&req=5

Figure 1: Timing of the treatment protocol. SS = Saturday, Sunday; RT = radiotherapy; IAC = intra-arterial chemotherapy.
Mentions: Figure 1 summarizes the timing of the treatment protocol. The planned dose of carboplatin per cycle was 350 mg/m2 with a maximum amount of 1,4 g/m2 given in 4 cycles, every 2 weeks. No pharmacokynetic analyses were performed to select the dose of the drug, but it was chosen according to our previous experience of induction intra-arterial chemotherapy [15]. Carboplatin was administered intra-arterially (i.a.), dissolved in 80 mL of 0,9% saline and infused over 15-20 min by a battery-operated pump (Medrad Mark 5 Plus) with an infusion velocity of 4-6 mL/min. An angiographic catheter (Glidecath Radicofocus 5F Terumo) was introduced percutaneously under local anesthesia (10 mL of 2% lidocaine solution) into the common femoral artery, according to the Seldinger technique. The catheter tip was placed in the external carotid artery, under radiographic control. Diagnostic transfemoral carotid arteriography was performed and the most suitable branch of the artery, providing the main blood supply to the tumour, was selectively catheterised. The catheter was removed immediately after the infusion. A simultaneous intravenous (i.v.) infusion of 250 mL of 0,9% saline was administered. Dexamethasone (4 mg) and ondansetron (1 g) dissolved in 100 mL of 0,9% saline were administered i.v. 1 hour before the infusion.

Bottom Line: The aim of the present study was to evaluate the survival, efficacy and safety of a modified RADPLAT-like protocol using carboplatin instead of cisplatin.Forty-four (98%) of the 45 patients who completed the protocol and 10 (91%) of the 11 who did not, were free of disease at the end of the treatment, for a comprehensive 96% of CR overall.Haematological and non-haematological toxicities are virtually similar, but carboplatin has the advantage in that it is not nephrotoxic and can be used at very high doses without any significant increase in the extent of side effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico S, Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy. giulia.bertino@tin.it

ABSTRACT

Background: The aim of the present study was to evaluate the survival, efficacy and safety of a modified RADPLAT-like protocol using carboplatin instead of cisplatin.

Methods: Fifty-six patients with primary head and neck squamous cell carcinoma received 4 cycles of intra-arterial carboplatin (350 mg/m2 per cycle every 2 weeks), with concurrent three-dimensional conformal radiation therapy.

Results: Two major and 4 minor complications were observed. Forty-five of the 56 patients (80%) completed the protocol, while 11 (20%) patients had to discontinue the intra-arterial infusions due to the occurrence of severe haematological toxicity, but were able to complete radiotherapy. Forty-four (98%) of the 45 patients who completed the protocol and 10 (91%) of the 11 who did not, were free of disease at the end of the treatment, for a comprehensive 96% of CR overall. After a median 23.55 months (range: 2 to 58 months) of follow-up, 40 patients (71%) are alive and disease-free, 1 (2%) is alive but affected by disease and 15 (27%) have died of the disease or other causes.

Conclusion: Intra-arterial carboplatin administration with concurrent three-dimensional conformal radiation therapy seems to be a promising alternative to RADPLAT in the treatment of advanced head and neck tumours. Haematological and non-haematological toxicities are virtually similar, but carboplatin has the advantage in that it is not nephrotoxic and can be used at very high doses without any significant increase in the extent of side effects.

Show MeSH
Related in: MedlinePlus