Selective Intraarterial Chemotherapy

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The selective administration of chemotherapy through intra-arterial infusion offers the advantage of a more direct drug delivery to the tumor site at a higher local concentration than can be achieved with systemic therapy. This technique was initially attempted with modest results similar to those obtained by surgery and postoperative radiation ther-apy.53 Shibuya suggested that one problem was the multiplicity of feeding arteries supplying the maxillary sinus causing an irregular, lower distribution of intra-arterially infused chemotherapy.54 A study by Lee reviewed 24 patients treated with selective intraarterial cisplatin and bleomycin through the internal maxillary artery, combined with intravenous 5-fluo-rouracil, and followed by radiation therapy and/or surgery. Although long-term follow-up was not available, 43 percent achieved a complete response, 48 percent a partial response, and only 9 percent a minimal response.37 Two patients died from complications related to the selective chemotherapy. Robbins has treated a variety of advanced head and neck cancers using selective intra-arterial cisplatin with con-

Total Maxillectomy
Figures 11-10 and 11-11. Oblique and palatal views of a skull delineating the osteotomies required for a total maxillectomy.

comitant radiation therapy and intravenous sodium thiosulfate neutralization. Sodium thiosulfate binds covalently to cisplatin and forms a product that is nontoxic and devoid of antitumor activity, thereby reducing side effects and permitting a high cisplatin concentration to be delivered to the tumor site. In a group of 24 patients with all types of stage IV head and neck carcinoma, Robbins reported an impressive complete response rate of 96 percent, and an overall and disease-free 3-year survival of 88 percent and 53 percent respectively.38-39

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