Abstract
Intra-arterial chemoradiotherapy using superficial temporal and occipital arteries demonstrates good local control and overall survival rates due to the advantage of simultaneous infusion of the anticancer agent with synergistic effects of chemotherapy and radiotherapy. However, local and regional recurrence after the treatment remains a common cause of failure in oral cancer therapy, thus salvage treatment is necessary. We evaluate the prognosis and postoperative complications of salvage surgery after intra-arterial chemoradiotherapy for advanced oral cancer patients.
Between August 2006 and July 2009, a total of 304 patients with carcinoma of the head and neck were referred to the Department of Oral and Maxillofacial Surgery of the Yokohama City University Graduate School of Medicine, and 193 patients were treated in our institute. Among them, 102 patients (52.8%) with carcinoma of the oral cavity and no evidence of distant metastasis underwent intra-arterial chemotherapy via superficial temporal and occipital arteries combined with daily concurrent radiotherapy. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and daily concurrent radiotherapy (total 60 Gy) for 6 weeks. Four weeks after the completion of all treatments, the patients underwent biopsy of the primary lesion and other examinations such as MRI, CT, and ultrasound. Pathological complete response (pCR) of the primary site was achieved in 90 (88.2%) of the 102 patients. Residual disease at the primary site was seen in 12 patients (11.8%), and 4 patients (3.9%) showed local and neck recurrence after the treatment. Salvage surgery was performed in 10 cases (62.5%) among the patients with residual tumor and recurrence (16 cases), of which 5 had postoperative complications. Local recurrence occurred in 4 patients after salvage surgery. Six patients were alive without diseases.
