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Therapeutic efficacy of selective intra-arterial chemoradiotherapy with docetaxel and nedaplatin for fixed bulky nodal disease in head and neck cancer of unknown primary

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Abstract

Purpose

Fixed bulky nodal disease in patients with head and neck cancer of unknown primary (HNCUP) remains difficult to treat. This retrospective study evaluated the therapeutic efficacy of selective intra-arterial chemoradiotherapy with docetaxel and nedaplatin for fixed bulky nodal disease in HNCUP.

Methods

Data from seven consecutive patients with fixed bulky nodal disease in HNCUP who had undergone selective intra-arterial chemoradiotherapy were analyzed. Whole pharyngeal mucosa and all bilateral nodal areas were irradiated (total dose 50 Gy), and bulky nodal lesions were provided an additional 20 Gy. Intra-arterial chemotherapy used a combination of nedaplatin (80 mg/m2) and docetaxel (60 mg/m2). Outcome measures were local control, disease-free survival, overall survival, and adverse events. Statistical analyses were performed using the Kaplan–Meier method.

Results

Median follow-up period was 24 months (range 9–64). All patients had extracapsular extension (N3b) on imaging and clinical findings. Symptoms due to bulky disease were neck discomfort (100%), tumor bleeding (43%), tracheal obstruction (14%), and carotid sinus syndrome (28%). Median value for maximum diameter of cervical disease was 84 mm (range 70–107), and 3-year local control, disease-free survival, and overall survival rates were 100, 54, and 64%, respectively. Symptoms due to bulky disease disappeared in all patients after intra-arterial chemoradiotherapy. Grade 4 leukopenia occurred in two patients (28%) as an acute adverse event. No other serious acute adverse events were observed.

Conclusion

Selective intra-arterial chemoradiotherapy with docetaxel and nedaplatin can potentially achieve both favorable local control and survival in in HNCUP with fixed bulky nodal disease.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Keiichi Nishimaki, Chief of Neurosurgery, Akita Red Cross Hospital, and Satoshi Takahashi, Associate Professor of Radiology, Akita University School of Medicine, for useful discourse on neuro-interventional radiology.

Funding

No funding from any source was received in association with this work.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan

    Joichi Heianna, Wataru Makino, Hayato Tomita, Takuro Ariga, Kazuki Ishikawa, Shota Takehara, Hitoshi Maemoto & Sadayuki Murayama

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medical Science, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan

    Hitoshi Hirakawa & Shinya Agena

  3. Department of Radiology, St Marianna University School of Medicine, 2-6-1, Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan

    Hayato Tomita

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Contributions

JH, WM, KI, and ST were responsible for the conceptualization. JH, WM, HM, and TA designed the study. HH and SA were responsible for use of the patient-reported outcomes following initial treatment. JH and HT were responsible for data curation and formal analysis. JH was responsible for ethics approval and writing the original draft. SM was responsible for supervision. All authors contributed to patient inclusion and manuscript writing and editing.

Corresponding author

Correspondence to Joichi Heianna.

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Conflict of interest

The authors declare no relationships with any companies whose products or services may be related with the subject matter of the article.

Ethical approval

This single-center retrospective study was approved by the ethics committee of the University of Ryukyus for Medical and Health Research Involving Human Subjects (reference number: 1443) and was conducted in accordance with the principles of the Declaration of Helsinki.

Consent to participate

This study was retrospective in nature, the requirement for written informed consent from the patients was waived.

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Heianna, J., Makino, W., Hirakawa, H. et al. Therapeutic efficacy of selective intra-arterial chemoradiotherapy with docetaxel and nedaplatin for fixed bulky nodal disease in head and neck cancer of unknown primary. Eur Arch Otorhinolaryngol 279, 3105–3113 (2022). https://doi.org/10.1007/s00405-021-07121-9

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