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Strahlentherapie und Onkologie

, Volume 190, Issue 2, pp 181–185 | Cite as

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma

  • Y. Mukai
  • M. Hata
  • K. Mitsudo
  • I. Koike
  • T. Koizumi
  • S. Oguri
  • M. Kioi
  • M. Omura
  • I. Tohnai
  • T. Inoue
Original article

Abstract

Purpose

The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma.

Methods and materials

In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors.

Results

Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1–15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12–79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment.

Conclusion

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma.

Keywords

Gingival neoplasms Radiation therapy Retrograde superselective intra-arterial chemotherapy Oral cancer Head and neck cancer 

Strahlenbehandlung des Gingivakarzinoms mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie

Zusammenfassung

Hintergrund und Ziel

Das Ziel dieser Studie war die Überprüfung der Effizienz und Toxizität einer Strahlenbehandlung des Gingivakarzinoms mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie.

Patienten und Methoden

Insgesamt 34 Patienten (21 Männer und 13 Frauen) mit Zahnfleischplattenzellkarzinom erhielten eine Strahlenbehandlung mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie. Die Behandlung umfasste eine tägliche externe Bestrahlung mit gleichzeitiger retrograder, superselektiver intraarterieller Infusion von Cisplatin und Docetaxel. Die Tumore wurden mit einer durchschnittlichen Gesamtdosis von 60 Gy in 30 Fraktionen bestrahlt.

Ergebnisse

Eine komplette Remission (CR) wurde bei 29 der 34 Patienten (85 %) erzielt; 5 Patienten hatten Resttumore. Von den 29 Patienten mit einer CR wiesen 2 Patienten lokale Rezidive und 1 Patient 1–15 Monate nach der Behandlung Fernmetastasen auf. Nach einer durchschnittlichen Beobachtungszeit von 36 Monaten (12–79 Monate) hatten 26 der 36 Patienten überlebt; 4 Patienten verstarben an Krebs und 4 verstarben an anderen, nicht krebsbezogenen Ursachen. Sowohl 3 und 5 Jahre nach der Behandlung betrug die Gesamtüberlebensrate 79 % und die ursachenspezifische Überlebensrate 85 %. Eine Osteoradionekrose des Unterkiefers trat nach der Behandlung bei 1 Patienten auf.

Schlussfolgerung

Die Strahlenbehandlung mit gleichzeitiger retrograder, superselektiver intraarterieller Chemotherapie war effektiv und sicher bei der Behandlung des Gingivakarzinoms. Diese Therapie kann eine vielversprechende, heilende und organsparende Behandlungsmöglichkeit für Gingivakarzinome darstellen.

Schlüsselwörter

Gingivaneoplasien Strahlentherapie Retrograder superselektiver intraarterielle Chemotherapie Mundkrebs Kopf- und Halskrebs 

Notes

Compliance with ethical guidelines

Conflict of interest. Y. Mukai, M. Hata, K. Mitsudo, I. Koike, T. Koizumi, S. Oguri, M. Kioi, M. Omura, I. Tohnai, and T. Inoue state that there is no conflict of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

References

  1. 1.
    Deantonio L, Masini L, Brambilla M et al (2013) Dysphagia after definitive radiotherapy for head and neck cancer. Correlation of dose-volume parameters of the pharyngeal constrictor muscles. Strahlenther Onkol 189:230–236PubMedCrossRefGoogle Scholar
  2. 2.
    Eicher SA, Overholt SM, El-Naggar AK et al (1996) Lower gingival carcinoma. Arch Otolaryngol Head Neck Surg 122:634–638PubMedCrossRefGoogle Scholar
  3. 3.
    Fattah HEL, Zaghloul A, Pedemonteet E et al (2012) Pre-prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient. Med Oral Patol Oral Cir Bucal 17:262–270CrossRefGoogle Scholar
  4. 4.
    Fernando M, Guerra M, Gı’as LN et al (2003) Marginal and segmental mandibulectomy patients with oral cancer: a statistical analysis of 106 cases. Int J Oral Maxillofac Surg 61:1289–1296CrossRefGoogle Scholar
  5. 5.
    Homma A, Furuta Y, Suzuki F et al (2005) Rapid super selective high-dose cisplatin infusion with concomitant radiotherapy for advanced head and neck cancer. Head Neck 27:65–71PubMedCrossRefGoogle Scholar
  6. 6.
    Kobayashi W, The BG, Sakaki H et al (2010) Superselective intra-arterial chemoradiotherapy with docetaxel-nedaplatin for advanced oral cancer. Oral Oncol 46:860–863PubMedCrossRefGoogle Scholar
  7. 7.
    Kudoh T, Ikushima H, Kudoh K et al (2010) High-dose-rate brachytherapy for patients with maxillary gingival carcinoma using a novel customized intraoral mold technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:102–108CrossRefGoogle Scholar
  8. 8.
    Lambrecht M, Nevens D, Nuyts S (2013) Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer. Strahlenther Onkol 189:223–229PubMedCrossRefGoogle Scholar
  9. 9.
    Lin CY, Wang HM, Kang CJ et al (2010) Primary tumor site as a predictor of treatment outcome for definitive radiotherapy of advanced-stage oral cavity cancers. Int J Radiat Oncol Biol Phys 78:1011–1019PubMedCrossRefGoogle Scholar
  10. 10.
    Lozza L, Cerrotta A, Gardani G et al (1997) Analysis of risk factors for mandibular bone radionecrosis after exclusive low dose-rate brachytherapy for oral cancer. Radiother Oncol 44:143–147PubMedCrossRefGoogle Scholar
  11. 11.
    Lubek J, El-Hakim M, Salama AR et al (2011) Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection. Br J Oral Maxillofac Surg 49:182–185PubMedCrossRefGoogle Scholar
  12. 12.
    Mitsudo K, Koizumi T, Iida M et al (2012) Thermochemoradiation therapy using superselective intra-arterial infusion via superficial temporal and occipital arteries for oral cancer with N3 cervical lymph node metastases. Int J Radiat Oncol Biol Phys 83:639–645CrossRefGoogle Scholar
  13. 13.
    Mitsudo K, Shigetomi T, Fujimoto Y et al (2011) Oragan preservation with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via a superficial temporal artery for T3 and T4 head and neck cancer. Int J Radiat Oncol Biol Phys 79:1428–1435PubMedCrossRefGoogle Scholar
  14. 14.
    Patel RS, Clark JR, Dirven R et al (2009) Prognostic factors in the surgical treatment of patients with oral carcinoma. ANZ J Surg 79:19–22PubMedCrossRefGoogle Scholar
  15. 15.
    Pathak KA, Mathur N, Talole S et al (2007) Squamous cell carcinoma of the superior gingival-buccal complex. Oral Oncol 43:774–779PubMedCrossRefGoogle Scholar
  16. 16.
    Rao LP, Shukla M, Sharmaet V et al (2012) Mandibular conservation in oral cancer. Surg Oncol 2:109–118CrossRefGoogle Scholar
  17. 17.
    Schliephake H, Jamil MU (2002) Prospective evaluation of quality of life after oncologic surgery for oral cancer. Int J Oral Maxillofac Surg 31:427–433PubMedCrossRefGoogle Scholar
  18. 18.
    Shah JP, Gil Z (2009) Current concepts in management of oral cancer—surgery. Oral Oncol 45:394–401PubMedCrossRefGoogle Scholar
  19. 19.
    Shingaki S, Nomura T, Takada M et al (2002) Squamous cell carcinoma of the mandibular alveolus: analysis of prognostic factors. Oncology 62:17–24PubMedCrossRefGoogle Scholar
  20. 20.
    Tribius S, Sommer J, Prosch C et al (2013) Xerostomia after radiotherapy. What matters—mean total dose or dose to each parotid gland? Strahlenther Onkol 189:216–222PubMedCrossRefGoogle Scholar
  21. 21.
    Wolfensberger M, Zbaeren P, Dulguerov P et al (2001) Surgical treatment of early oral carcinoma-results of a prospective controlled multicenter study. Head Neck 23:525–530PubMedCrossRefGoogle Scholar
  22. 22.
    Yoshimura R, Shibuya H, Hayashi K et al (2011) Disease control using low-dose-rate-brachytherapy is unaffected by comorbid severity in oral cancer patients. Br J Radiol 84:930–938PubMedCrossRefGoogle Scholar
  23. 23.
    Yoshimura R, Shibuya H, Miura M et al (2009) Quality of life of oral cancer patients after low-dose-rate interstitial brachytherapy. Int J Radiat Oncol Biol Phys 73:772–778PubMedCrossRefGoogle Scholar

Copyright information

© Springer Heidelberg Berlin 2013

Authors and Affiliations

  • Y. Mukai
    • 1
  • M. Hata
    • 1
  • K. Mitsudo
    • 2
  • I. Koike
    • 1
  • T. Koizumi
    • 2
  • S. Oguri
    • 2
  • M. Kioi
    • 2
  • M. Omura
    • 3
  • I. Tohnai
    • 2
  • T. Inoue
    • 1
  1. 1.Department of RadiologyYokohama City University Graduate School of MedicineKanazawa-ku, Yokohama, KanagawaJapan
  2. 2.Department of Oral and Maxillofacial SurgeryYokohama City University Graduate School of MedicineYokohama, KanagawaJapan
  3. 3.Department of Radiation OncologyShonankamakura General HospitalKamakura, KanagawaJapan

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