Korogi Y, Hirai T, Nishimura R, Hamatake S, Sakamoto Y, Murakami R, Baba Y, Arakawa A, Takahashi M, Uji Y
Department of Radiology, Kumamoto University School of Medicine, Japan.
AJR Am J Roentgenol. 1995 Nov;165(5):1269-72. doi: 10.2214/ajr.165.5.7572516.
The purpose of this study was to assess the initial clinical response to superselective intraarterial infusion of cisplatin for treating stage III and stage IV squamous cell carcinoma of the mouth.
Thirteen patients received intraarterial cisplatin therapy. The tumors were located in the tongue (n = 7), gingiva (n = 3), buccal mucosa (n = 1), hard palate (n = 1), and floor of the mouth (n = 1). A coaxial technique was used to place microcatheters in the lingual, facial, inferior alveolar, buccinator, and distal internal maxillary arteries, depending on tumor location. The feeding vessels were identified by staining the tumor with infusion of indigocarmine dye in the selected vessel. Relatively low-dose cisplatin (30-40 mg/m2) was injected at the rate of 50 mg/hr. Two or three injections were performed, with a 1-week interval between injections. After chemotherapy, eight patients underwent surgery, four had radiation therapy, and one had both.
Thirty-four intraarterial infusions were done successfully without any complications. Arterial infusion of indigocarmine dye was useful for exact identification of feeding vessels, especially when the tumor was extensive, at the margin of the arterial supply, or near the midline. The overall response rate was 92% (complete response [tumor completely resolved], 38%; partial response [tumor reduction > or = 50%], 54%). Ten of 13 patients had no recurrence from 4 to 19 months (mean, 10 months) after treatment. Two patients died of metastatic diseases 6 months after surgery or radiation therapy. One patient had local recurrence 8 months after surgery and postoperative irradiation. No systemic toxicity such as renal failure, liver dysfunction, or bone marrow suppression was observed. Mild and transient local toxicity such as edema or mucositis of the infused area was relatively common. Trigeminal neuralgialike symptoms and reduced mouth opening occurred in two cases and one case, respectively, probably due to direct toxicity to the peripheral trigeminal nerve and masticatory muscles, respectively.
Superselective intraarterial infusion of low-dose cisplatin is feasible and safe and may have important applications in treating advanced carcinoma of the mouth.
本研究旨在评估超选择性动脉内输注顺铂治疗Ⅲ期和Ⅳ期口腔鳞状细胞癌的初始临床反应。
13例患者接受动脉内顺铂治疗。肿瘤位于舌部（n = 7）、牙龈（n = 3）、颊黏膜（n = 1）、硬腭（n = 1）和口底（n = 1）。根据肿瘤位置，采用同轴技术将微导管置入舌动脉、面动脉、下牙槽动脉、颊肌动脉和上颌内动脉远端。通过在选定血管内注入靛胭脂染料对肿瘤进行染色来识别供血血管。以50mg/小时的速率注入相对低剂量的顺铂（30 - 40mg/m²）。进行两到三次注射，注射间隔为1周。化疗后，8例患者接受了手术，4例接受了放疗，1例两者都接受了。
成功进行了34次动脉内输注，无任何并发症。动脉内注入靛胭脂染料有助于准确识别供血血管，尤其是当肿瘤广泛、位于动脉供应边缘或靠近中线时。总体缓解率为92%（完全缓解[肿瘤完全消退]，38%；部分缓解[肿瘤缩小≥50%]，54%）。13例患者中有10例在治疗后4至19个月（平均10个月）无复发。2例患者在手术或放疗后6个月死于转移性疾病。1例患者在手术和术后放疗后8个月出现局部复发。未观察到诸如肾衰竭、肝功能障碍或骨髓抑制等全身毒性。轻度和短暂的局部毒性如输注区域的水肿或黏膜炎较为常见。分别有2例和1例出现三叉神经痛样症状和张口受限，可能分别是由于对周围三叉神经和咀嚼肌的直接毒性所致。
超选择性动脉内输注低剂量顺铂是可行且安全的，可能在治疗晚期口腔癌方面有重要应用。
