Introduction
Intra-arterial chemotherapy for cancer of the head and neck is a well-established but evolving technique for the treatment of advanced tumors in that region. It is intended for patients for whom traditional therapy has failed. As the procedure evolves, it may gain wider application. It is a method that requires a team approach. The basic members of the team are a neuroendovascular physician and an oncologist. Additional members of the team ideally include a head and neck surgeon and a radiation oncologist. Current techniques involve selective catheterizations of the branches of the ECA. Approaches in the literature include both a traditional femoral approach and a surgical approach for long-term treatment with a cut-down on the superficial temporal artery and implantation of a pump.
Indications
The procedure shall be deemed appropriate and indicated in the following situations: 1) standard therapy regimens have failed, and the intra-arterial chemotherapy is being performed as in an effort to control tumor growth; 2) intra-arterial chemotherapy is being performed as a standard part of a treatment regimen, as determined by the patient's treating physicians; and 3) the patient is enrolled in an institutional review board-approved study of intra-arterial chemotherapy as an alternative or adjunct to standard treatment of the tumor.
Threshold:
When intra-arterial chemotherapy is performed for other indications, a review should be prompted.
Efficacy
The response to treatment varies with the initial grade and type of tumor. Initial response rates have been reported to be as high as 100%. Complete response is unusual. Efficacy of the therapy should be judged in comparison with standard treatment as it evolves over time.
Safety
The historical data indicate a high rate of safety for the procedure. Complications should be categorized into three groups: those associated with angiography, with systemic toxicity, and with local toxicity.
Complications Associated with Angiography
The potential complications associated with and thresholds for neuroangiography are outlined elsewhere. Unique complications associated with long-term catheterization using the slow infusion method include thrombophlebitis and catheter infection. Thresholds for these latter complications are outside the scope of this document.
Systemic Toxicity
Systemic toxicity of the chemotherapy agent can be rated according to the standard criteria outlined by the Eastern Cooperative Oncology Group. Systemic toxicity should not exceed that of IV therapy with the same agent.
Local Toxicity
Local toxicity includes hemicranial alopecia, mucositis, dermatitis, skin necrosis, and peripheral and cranial nerve palsies (see table below).
Threshold:
If thresholds for complications or toxicity are exceeded, a review should be conducted.
Bibliography
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