Sakuma Kaname, Kii Tomoyuki, Machida Toko, Fuwa Nobukazu, Tanaka Akira
Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan.
Department of Radiation Oncology, Central Japan International Medical Center, Minokamo, Gifu 505-8510, Japan.
Mol Clin Oncol. 2023 Aug 10;19(4):76. doi: 10.3892/mco.2023.2672. eCollection 2023 Oct.
Superselective intra-arterial chemoradiotherapy (SSIACRT) is one of the curative treatments for advanced oral cancer. SSIACRT can reportedly treat cervical lymph node metastases in the level I-IIA area by super selectively catheterizing the facial artery (FA) and infusing drugs. However, since advanced oral cancer lesions involve a number of feeding vessels, retrograde treatment requires the placement of catheters from the superficial temporal artery (STA) and occipital artery (OA). Furthermore, in the case of level IIB lymph node metastasis, the catheter must be changed because it is necessary to administer anticancer drugs to more than three routes, including the OA, when the feeding arteries of the primary tumor are combined. The external carotid artery sheath (ECAS) system used in the present study involves the insertion of a microcatheter or steering catheter from one route of the STA, allowing selection of numerous feeding vessels, including the OA. The ECAS system can facilitate the administration of chemotherapy via the STA simultaneously to the maxillary artery, lingual artery, FA and OA. The present study describes cases of maxillary gingival cancer and tongue cancer with cervical lymph node metastasis, which were treated with the ECAS system via the STA; the treatment successfully controlled both the primary tumor and cervical lymph node metastasis. In the two cases described in the present study, metastatic lymph nodes were found in the level ⅠB and ⅡB region, but were successfully treated by administering cisplatin via the OA, in addition to the primary lesion. To date, to the best of our knowledge, there is no case report clearly referring to the treatment of lymph node metastasis using the ECAS system. In conclusion, SSIACRT using ECAS may be considered a useful treatment for oral cancer with cervical lymph node metastasis.
超选择性动脉内放化疗（SSIACRT）是晚期口腔癌的根治性治疗方法之一。据报道，SSIACRT可通过超选择性插管至面动脉（FA）并注入药物来治疗Ⅰ-ⅡA区的颈部淋巴结转移。然而，由于晚期口腔癌病变涉及多条供血血管，逆行治疗需要从颞浅动脉（STA）和枕动脉（OA）放置导管。此外，在ⅡB区淋巴结转移的情况下，当原发肿瘤的供血动脉合并时，由于需要通过三条以上途径（包括枕动脉）给予抗癌药物，因此必须更换导管。本研究中使用的颈外动脉鞘（ECAS）系统涉及从STA的一条途径插入微导管或导向导管，从而能够选择包括枕动脉在内的众多供血血管。ECAS系统可便于通过STA同时对上颌动脉、舌动脉、面动脉和枕动脉进行化疗给药。本研究描述了经STA使用ECAS系统治疗的上颌牙龈癌和舌癌伴颈部淋巴结转移的病例；该治疗成功控制了原发肿瘤和颈部淋巴结转移。在本研究描述的两例病例中，在ⅠB区和ⅡB区发现了转移性淋巴结，但除了原发灶外，通过枕动脉给予顺铂成功治疗了这些转移灶。据我们所知，迄今为止尚无明确提及使用ECAS系统治疗淋巴结转移的病例报告。总之，使用ECAS的SSIACRT可被认为是治疗伴有颈部淋巴结转移的口腔癌的一种有效方法。
