Neo-Adjuvant intra-arterial chemotherapy by Cisplatin and 5-FU for squamous cell carcinoma of the oral cavity

Abstract

The association of Cisplatin with continous 5-FU infusion has led to an improved response rate in previously untreated head and neck cancer [1, 2]. However, this combination protocol is accompanied by a significant incidence of systemic toxicity that is often acceptable but sometimes severe, depending on dose or on specific site. Moreover, our experience with this chemotherapy protocol indicated that the best results were obtained for tumors of the oropharynx and hypopharynx and that oral cavity lesions were the most refractory [3]. These limitations in treatment tolerance and response suggest that the intra-arterial route may be an interesting alternative to the intravenous route for the delivery of this combination. This approach is further justified by pharmacological characteristics of both Cisplatin and 5-FU. Cisplatin is highly bound to plasma proteins so that when given intravenously, only a limited part of the active drug (free drug action) is accessible to target tissues. Thus, it is not surprising that higher platinum levels were found in tumor biopsies after infra-arterial administration, as compared with the intravenous route in head and neck cancer patients [4].On the other hand, 5-FU systemic clearance is particularly high and, thus, represents a drug of choice for intra-arterial chemotherapy [5].