Graeber I P, Eshraghi A A, Paiva M B, Paek W H, Castro D J, Jovanovic S, Scherer H, Soudant J, Saxton R E
Department of Head and Neck Surgery, Free University of Berlin, Germany.
Laryngoscope. 1999 Mar;109(3):447-54. doi: 10.1097/00005537-199903000-00020.
OBJECTIVES/HYPOTHESIS: Interstitial laser therapy (ILT) has become useful for tumor palliation in patients with advanced head and neck cancer. Cisplatinum chemotherapy also is a frequent adjuvant treatment for recurrent tumors, but systemic toxicity limits application. Intratumor cisplatinum injection combined with ILT may improve therapy of these recurrent tumors with reduced toxicity.
Prospective. Tumor transplants were injected with cisplatinum in a gel implant before ILT to evaluate treatment response and toxicity in a preclinical study.
UCLA-P3 human squamous cell carcinoma tumors were grown as subcutaneous transplants in nude mice and treated by intratumor injection of 2 mg/mL cisplatinum in a slow-release, collagen-based gel carrier 4 hours before interstitial implantation of Nd:YAG laser fiberoptics to induce local tumor hyperthermia. Treatment efficacy and toxicity were followed for 12 weeks after combined drug and laser therapy compared with ILT alone.
Combined cisplatinum gel and ILT was a significant improvement (P < .01 by chi-square test) and induced 57% complete responses without regrowth in 21 transplanted tumors compared with only 24% in 21 tumors after ILT alone during 12-week follow-up. Recurrences in both cases appeared to result from nonuniform laser energy delivery within tumors via the implanted fiberoptic tip.
The results of this experimental combined cisplatinum and ILT study suggest it may be possible to improve treatment of advanced head and neck cancer by intratumor injection of gel implants containing the drug followed by interstitial Nd:YAG laser hyperthermia.
目的/假设：间质激光治疗（ILT）已成为晚期头颈癌患者肿瘤姑息治疗的有效方法。顺铂化疗也是复发性肿瘤常用的辅助治疗方法，但全身毒性限制了其应用。瘤内注射顺铂联合ILT可能会降低毒性，提高这些复发性肿瘤的治疗效果。
前瞻性研究。在临床前研究中，在ILT前将顺铂注射到凝胶植入物中的肿瘤移植体中，以评估治疗反应和毒性。
将UCLA-P3人鳞状细胞癌肿瘤作为皮下移植瘤种植于裸鼠体内，在植入Nd:YAG激光光纤进行间质植入以诱导局部肿瘤热疗前4小时，通过瘤内注射2mg/mL顺铂于缓释胶原基凝胶载体中进行治疗。与单纯ILT相比，联合药物和激光治疗后随访12周，观察治疗效果和毒性。
顺铂凝胶联合ILT有显著改善（卡方检验P<0.01），在21个移植瘤中诱导57%完全缓解且无复发，而单纯ILT的21个肿瘤在12周随访期间仅为24%。两种情况下的复发似乎都是由于通过植入的光纤尖端在肿瘤内激光能量传递不均匀所致。
本实验性顺铂与ILT联合研究结果表明，通过瘤内注射含药凝胶植入物，随后进行间质Nd:YAG激光热疗，可能改善晚期头颈癌的治疗。
