Intra-arterial chemotherapy targeting metastatic cervical lymph nodes in head and neck cancer

Acta Otolaryngol. 2021 Dec;141(12):1063-1069. doi: 10.1080/00016489.2021.2003858. Epub 2021 Nov 26.

Abstract

Background: Large cervical lymph nodes and the extranodal extension of metastatic lymph nodes are considered poor prognostic factors in head and neck squamous cell carcinoma (HNC).

Aims/objectives: The efficacy of intra-arterial chemotherapy (iaCT) targeting lymph node (LN) in HNC was examined.

Materials and methods: We performed a retrospective review of 41 patients with laryngeal and hypopharyngeal cancer showing metastatic cervical LN larger than 20 mm treated with iaCT with concurrent radiotherapy. The administration of cisplatin into LN was divided into three groups: no administration (NO), via the same artery as that supplying the primary tumor (SAME), and via a different artery from that supplying the primary tumor (DIFFERENT).

Results: A trend toward a more favorable three-year regional control in DIFFERENT compared to NO was observed, although the mean size of LN in DIFFERENT was larger than in the other groups. A better regional control was obtained in both DIFFERENT (p < .05) and DIFFERENT + SAME (p < .05) when overall rather than partial enhancement of lymph node by CT angiography was observed. Extranodal extension could be a factor predicting unfavorable regional control.

Conclusions/significance: Targeting lymph node may be helpful to avoid neck dissection when iaCT was planned in HNC with relatively large LNs.

Keywords: CT angiography; Head and neck cancer; concurrent chemoradiotherapy; intra-arterial chemotherapy; lymph nodes.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Antineoplastic Agents / administration & dosage*
  • Cisplatin / administration & dosage*
  • Female
  • Humans
  • Hypopharyngeal Neoplasms / drug therapy
  • Hypopharyngeal Neoplasms / pathology*
  • Infusions, Intra-Arterial / methods
  • Laryngeal Neoplasms / drug therapy
  • Laryngeal Neoplasms / pathology*
  • Lymphatic Metastasis / drug therapy*
  • Lymphatic Metastasis / radiotherapy
  • Male
  • Middle Aged
  • Neck
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck / drug therapy
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / secondary*

Substances

  • Antineoplastic Agents
  • Cisplatin