Regional arterial chemotherapy for advanced carcinoma of the head and neck. A ten‐year review

A 10‐year experience (1961‐1971) of prolonged arterial infusion chemotherapy in 94 patients with advanced carcinoma of the head and neck was reviewed. The antimetabolites, FUdR, 5‐FU, and MTX‐folinic acid, were infused for prolonged periods. Seventy‐one per cent of patients had catheters inserted into the common carotid artery with 13.8% into the external carotid artery. Forty‐three patients achieved a minimum of 50% tumor regression with 24 patients (26%) achieving 100% objective regression with enhanced survival. Patients with increased toxicity had increased responses but decreased survival. Mild‐to‐moderate toxicity produced optimal response to survival ratio. No correlation was found between total cumulative drug dosage and response, survival, and toxicity. Thirty‐one per cent of patients survived one year from onset of chemotherapy. Minor complications occurred in 43.7% of patients with 8.9% having cerebrovascular accidents that were often transient. Severe systemic drug toxicity occurred in about 45% of patients, and severe local toxicity occurred in 30% of patients. Death from drug or catheter toxicity, or both, occurred in 2% of patients. The 43 patients (46%) with objective regression rates of at least 50% were poor risk patients with advanced disease, commonly referred to us. This suggests that earlier use of these procedures in combination with other modalities in better risk patients may offer its greatest benefit.