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1 Department of Radiology, Istituto Nazionale Tumori, Via Venezian, 1, Milano
20133, Italy.
2 Department of Radiotherapy, Istituto Nazionale Tumori, Milano 20133,
Italy.
3 Department of Nuclear Medicine, Istituto Nazionale Tumori, Milano 20133,
Italy.
4 Department of Head and Neck Surgery, Ospedale di Lodi, Lodi 26900, Italy
5 Department of Head and Neck Surgery, Istituto Nazionale Tumori, Milano 20133,
Italy.
6 Department of Statistics and Biometry, Istituto Nazionale Tumori, Milano
20133, Italy.
OBJECTIVE. The purpose of our study was to evaluate the effectiveness of intraarterial infusion of paclitaxel incorporated into human albumin nanoparticles for use as induction chemotherapy before definitive treatment of advanced squamous cell carcinoma of the tongue.
SUBJECTS AND METHODS. Twenty-three previously untreated patients (age range, 27–75 years) who had carcinoma of the tongue (stage T3—T4, any N) received intraarterial therapy with paclitaxel incorporated into albumin nanoparticles delivered by transfemoral catheterization into the external carotid artery (10 patients), selectively into the lingual artery (12 patients), or into a faciolingual trunk (1 patient). Each patient received two to four infusions, with a 3-week interval between infusions. The dose administered was 230 mg/m2 in eight patients, 180 mg/m2 in six patients, and 150 mg/m2 in nine patients. Sixteen patients underwent surgery. Of these 16 patients, eight subsequently received radiotherapy, and three received a combination of chemotherapy and radiotherapy. Of the remaining seven patients, one received chemotherapy alone, four received radiotherapy alone, one received chemotherapy plus radiotherapy, and one refused any further treatment.
RESULTS. Sixty-seven infusions were performed successfully. Eighteen patients (78%) had a clinical and radiologic objective response (complete, 26%; partial, 52%). Three patients (13%) showed stable disease, and two (9%) showed disease progression. The four patients with complete clinical response who underwent surgery showed microscopic residual carcinoma measuring less than 1 mm in two patients, less than 5 mm in one patient, and less than 1 cm in one patient. The toxicities encountered were hematologic (grade 3) in two patients (8.6%) and neurologic (grade 4) in two patients (reversible paralysis of the facial nerve, 8.6%). Two catheter-related complications occurred: one reversible brachiofacial paralysis and one asymptomatic occlusion of the external carotid artery.
CONCLUSION. Intraarterial infusion of paclitaxel in albumin nanoparticles proved reproducible and effective and deserves further investigation as induction chemotherapy before definitive treatment of advanced tumors of the tongue, with a view to organ preservation.
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