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      <h1 class="highwire-cite-title" id="page-title">Head and Neck Chemotherapy</h1>  
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2001,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">22 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8 suppl) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">S16-S17; </span></div>
  
  
  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="section" id="sec-1"><h2 class="">Introduction</h2><p id="p-1">Intra-arterial chemotherapy for cancer of the head and neck is a well-established but evolving technique for the treatment of advanced tumors in that region. It is intended for patients for whom traditional therapy has failed. As the procedure evolves, it may gain wider application. It is a method that requires a team approach. The basic members of the team are a neuroendovascular physician and an oncologist. Additional members of the team ideally include a head and neck surgeon and a radiation oncologist. Current techniques involve selective catheterizations of the branches of the ECA. Approaches in the literature include both a traditional femoral approach and a surgical approach for long-term treatment with a cut-down on the superficial temporal artery and implantation of a pump.</p></div><div class="section" id="sec-2"><h2 class="">Indications</h2><p id="p-2">The procedure shall be deemed appropriate and indicated in the following situations: 1) standard therapy regimens have failed, and the intra-arterial chemotherapy is being performed as in an effort to control tumor growth; 2) intra-arterial chemotherapy is being performed as a standard part of a treatment regimen, as determined by the patient's treating physicians; and 3) the patient is enrolled in an institutional review board-approved study of intra-arterial chemotherapy as an alternative or adjunct to standard treatment of the tumor.</p><div id="sec-3" class="subsection"><h3>Threshold:</h3><p id="p-3">When intra-arterial chemotherapy is performed for other indications, a review should be prompted.</p></div></div><div class="section" id="sec-4"><h2 class="">Efficacy</h2><p id="p-4">The response to treatment varies with the initial grade and type of tumor. Initial response rates have been reported to be as high as 100%. Complete response is unusual. Efficacy of the therapy should be judged in comparison with standard treatment as it evolves over time.</p></div><div class="section" id="sec-5"><h2 class="">Safety</h2><p id="p-5">The historical data indicate a high rate of safety for the procedure. Complications should be categorized into three groups: those associated with angiography, with systemic toxicity, and with local toxicity.</p></div><div class="section" id="sec-6"><h2 class="">Complications Associated with Angiography</h2><p id="p-6">The potential complications associated with and thresholds for neuroangiography are outlined elsewhere. Unique complications associated with long-term catheterization using the slow infusion method include thrombophlebitis and catheter infection. Thresholds for these latter complications are outside the scope of this document.</p></div><div class="section" id="sec-7"><h2 class="">Systemic Toxicity</h2><p id="p-7">Systemic toxicity of the chemotherapy agent can be rated according to the standard criteria outlined by the Eastern Cooperative Oncology Group. Systemic toxicity should not exceed that of IV therapy with the same agent.</p></div><div class="section" id="sec-8"><h2 class="">Local Toxicity</h2><p id="p-8">Local toxicity includes hemicranial alopecia, mucositis, dermatitis, skin necrosis, and peripheral and cranial nerve palsies (see table below).<span class="disp-formula" id="disp-formula-1"><span class="highwire-responsive-lazyload"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" class="highwire-embed lazyload" alt="Embedded Image" data-src="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/22/8_suppl/S16/embed/graphic-1.gif"/><noscript><img class="highwire-embed" alt="Embedded Image" src="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/22/8_suppl/S16/embed/graphic-1.gif"/></noscript></span></span></p><div id="sec-9" class="subsection"><h3>Threshold:</h3><p id="p-9">If thresholds for complications or toxicity are exceeded, a review should be conducted.</p></div></div><div class="section ref-list" id="ref-list-1"><h2 class="">Bibliography</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.1"><div class="cit-metadata"><cite>Lee YY, Wallace S, Dimery I, Goepfert H,  <strong>Intraarterial chemotherapy of head and neck tumors.</strong> <span class="cit-source"><em>AJNR Am J Neuroradiol</em></span> <span class="cit-pub-date">1986</span>;<span class="cit-vol">7</span>:<span class="cit-fpage">343</span>-348</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo3OiI3LzIvMzQzIjtzOjQ6ImF0b20iO3M6MjU6Ii9ham5yLzIyLzhfc3VwcGwvUzE2LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.2" data-doi="10.1001/archotol.1993.01880180026004"><div class="cit-metadata"><cite>Moses BL, Chan DW, Hruban RH, Forastiere A, Richtsmeier WJ,  <strong>Comparison of intra-arterial and intravenous infusion of cisplatin for head and neck squamous cell carcinoma in a modified rat model.</strong> <span class="cit-source"><em>Arch Otolaryngol Head Neck Surg</em></span> <span class="cit-pub-date">1993</span>;<span class="cit-vol">119</span>:<span class="cit-fpage">612</span>-617</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1001/archotol.1993.01880180026004&amp;link_type=DOI" class="cit-ref-sprinkles 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class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=7497585&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F8_suppl%2FS16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.4"><div class="cit-metadata"><cite>Gore ME, Riches P, MacLennan K,  <strong>Phase I study of intra-arterial interleukin-2 in squamous cell carcinoma of the head and neck.</strong> <span class="cit-source"><em>Br J Cancer</em></span> <span class="cit-pub-date">1992</span>;<span class="cit-vol">66</span>:<span class="cit-fpage">405</span>-407</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=1503916&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F8_suppl%2FS16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.5"><div class="cit-metadata"><cite>Robbins KT, Storniolo AM, Kerber C,  <strong>Phase I study of highly selective supradose cisplatin infusions for advanced head and neck cancer.</strong> <span class="cit-source"><em>J Clin Oncol</em></span> <span class="cit-pub-date">1994</span>;<span class="cit-vol">12</span>:<span class="cit-fpage">2113</span>-2120</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiamNvIjtzOjU6InJlc2lkIjtzOjEwOiIxMi8xMC8yMTEzIjtzOjQ6ImF0b20iO3M6MjU6Ii9ham5yLzIyLzhfc3VwcGwvUzE2LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.6" data-doi="10.1002/1097-0142(19880301)61:5&lt;903::AID-CNCR2820610508&gt;3.0.CO;2-O"><div class="cit-metadata"><cite>Cheung DK, Regan J, Savin M, Gibberman V, Woessner W,  <strong>A pilot study of intraarterial chemotherapy with cisplatin in locally advanced head and neck cancers.</strong> <span class="cit-source"><em>Cancer</em></span> <span class="cit-pub-date">1988</span>;<span class="cit-vol">61</span>:<span class="cit-fpage">903</span>-908</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/1097-0142(19880301)61:5&lt;903::AID-CNCR2820610508&gt;3.0.CO;2-O&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi 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Decker, Inc  <span class="cit-pub-date">1985</span>;<span class="cit-fpage">461</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.8" data-doi="10.1097/00000421-198212000-00014"><div class="cit-metadata"><cite>Oken MM, Creech RH, Tormey DC,  <strong>Toxicity and response criteria of the Eastern Cooperative Oncology Group.</strong> <span class="cit-source"><em>Am J Clin Oncol</em></span> <span class="cit-pub-date">1982</span>;<span class="cit-vol">5</span>:<span class="cit-fpage">649</span>-655</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1097/00000421-198212000-00014&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=7165009&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F8_suppl%2FS16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.9"><div class="cit-metadata"><cite>Shimizu T, Sakakura Y, Hattori T, Yamaguchi N, Kubo M, Sakakura K,  <strong>Superselective intraarterial chemotherapy in combination with irradiation: preliminary report.</strong> <span class="cit-source"><em>Am J Otaryngol</em></span> <span class="cit-pub-date">1990</span>;<span class="cit-vol">11</span>:<span class="cit-fpage">131</span>-136</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label ref-label-empty"></span><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.8_suppl.S16.10" data-doi="10.1002/hed.2880140505"><div class="cit-metadata"><cite>Robbins KT, Storniolo AM, Kerber C, Seagren S, Berson A, Howell SB,  <strong>Rapid superselective high-dose cisplatin infusion for advanced head and neck malignancies.</strong> <span class="cit-source"><em>Head Neck</em></span> <span class="cit-pub-date">1992</span>;<span class="cit-vol">14</span>:<span class="cit-fpage">364</span>-371</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/hed.2880140505&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=1399569&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F8_suppl%2FS16.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 22</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 suppl </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2001 </div></div>
      
      
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