Carotid artery infusion via implantable port catheters for cancer of the tonsils

What is it about?

Chemoradiotherapy has a dominant role in therapy for head and neck cancers. However, impressive results are often disturbed by adverse events such as dysphagia, xerostomia, and functional speech and hearing loss. To avoid exceeding toxicity limits in patients with primary and recurrent cancers of the tonsils, chemotherapy was administered intra-arterially via implantable Jet-Port-Allround catheters. We report on patients with primary and recurrent cancers of the tonsils. Eleven patients who refused chemoradiation were included in this trial. Of the seven patients without prior therapy, one was stage I, one was stage III, three were stage IVA, one was stage IVB, and one was stage IVC. The four patients who were in progression after prior chemoradiation were stage IVA. The median follow-up time was 47 months (20 to 125 months). After the implantation of a Jet-Port-Allround catheter into the carotid artery, the patients received intra-arterial infusion chemotherapy with venous chemofiltration for systemic detoxification. The stage I patient received lower-dose chemotherapy without chemofiltration. The stage IVC patient with lung metastases and a primary tumor that extended across the midline to the contralateral tonsil received additional isolated thoracic perfusion chemotherapy.

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Why is it important?

In order to avoid exceeding toxicity from standard therapies, we considered a new treatment approach via implantable arterial port catheters. Thus, drugs can be administered easily without technically demanding placement of angiographic catheters, via the arterial route. Intra-arterial infusion generates high regional cytostatic concentrations despite low total dosage. In combination with simultaneous chemofiltration in the venous return from the tumor area, systemic toxicity can be kept low.

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