Advanced Cancer of the Head and Neck

IT IS probable that less than 30 per cent, of all neoplasms affecting the head and neck are cured by radical surgery or radiotherapy. The management of this large group of patients imposes a considerable strain on family doctor, surgeon, relatives and, not least, the patient. Many spend long lingering months in hospital until eventual local extension of the growth involves a major blood vessel and terminates their life in a sudden profuse haemorrhage. The rarity with which jnalignant tumours in this region metastasize and the accessibility of their blood supply, offers to the surgeon an almost unique opportunity for the use of intra-arterial chemotherapeutic agents. Changes in the size and appearance of the growth are readily visible and even the most advanced cases, when provided with tracheostomy and feeding tube, may live for many months enabling the therapeutic agent to be given for a reasonable length of time. Unfortunately there is no cytotoxic substance available as yet which will exert its effect solely upon the malignant cell without damaging normal host cells. A variety of techniques, using both alkylating agents and anti-metabolites, has been developed over the last 12 years in an attempt to localize the effects of the anti-cancer agents to the tumour tissue. Klopp (1950) was the first to administer such a substance directly into the arterial supply of a tumour bearing area. Nitrogen mustard (HN2) was given in fractional doses as a continuous regional intra-arterial infusion. Spillover into the systemic circulation resulted in undesirable side effects upon the bone marrow and alimentary system. Sullivan et al. (1959), utilized a similar approach but gave a supra-lethal dosage of an anti-metabolite, methotrexate, administering the specific metabolite, folinic acid, systemically as an antidote. They described regression of advanced tumours of the head and neck and further reports, using this technique, have been published recently (Westbury et al., Espiner et al., 1962). It is obvious from these reports that this technique is of limited