Jpn J Intervent Radiol Vol.24 No.1 2009

State of the Art
Intra-arterial Chemotherapy for Head and Neck Cancer

1. Regional Vascular Anatomy for Intra-arterial Infusion Chemotherapy of Head and Neck Malignancies

Department of Radiology, Iwate Medical University
Tatsuhiko Nakasato

Head and neck interventional radiologists are required to detect dominant blood supply to primary and cervical metastatic lesions with detailed knowledge of the vascular anatomy including risky anastomoses to avoid adverse neurological deficits. IVR-CT is helpful for detecting multiple feeders of tumors and dividing dose of chemotherapeutic agents administered into each feeder. Dangerous vascular anastomoses are cavernous ramus and meningoophthalmic arteries, which diverge from the middle meningeal artery in the territory of the internal maxillary artery, and the accessory meningeal artery having also an anastomosis with the internal carotid artery and the ophthalmic artery. The sphenopalatine artery also has ethmoidal anastomosis with the ophthalmic artery. The ascending pharyngeal artery has many connections to the internal carotid artery or the vertebral artery via the inferolateral trunk, mandibular anastomosis, jugular branch, and carotid branch or the hypoglossal artery of the neuromeningeal trunk which connects to the odontoid branch of the vertebral artery. A main feeder of vertical segment of the facial nerve is the stylomastoid branch from the posterior auricular artery or the occipital artery. An ischemic event in this branch may result in facial palsy. Several branches, such as the muscular branch for the sternocleidmastoid muscle, diverge from the occipital artery.These branches and more distal descending branches merge with the ascending cervical artery and the deep cervical artery, and they have a potential anastomosis with the artery of Adamkiewicz, which connects to the anterior spinal artery.

Key words

  • Head and neck cancer
  • Intra-arterial infusion chemotherapy
  • Vascular anatomy


2. Principles and Basic Techniques in Intra-arterial Chemotherapy for Head and Neck Cancers

Department of Diagnostic Radiology, Miyagi Cancer Center
Ko Matsumoto

Since the introduction of intra-arterial chemotherapy for head and neck squamous cell carcinomas using cis-diamminedichloroplatinum with concurrent radiotherapy by Robbins in the mid 1990s, a number of facilities in Japan have been participating in this unique treatment. Its technical dependence on interventional radiologists is enormous, but there is much to be desired among them in understanding the essence of this strategy. In the present paper the principles and basic interventional techniques which are essential in performing intra-arterial chemotherapy for head and neck cancers are described.
The pharmacological uniqueness of cis-diamminedichloroplatinum in this treatment is stressed and should be fully exploited in the clinical setting. Each procedure in implementation of the treatment is briefly explained. Among basic techniques a preventive means of intracatheter thrombus formation which is crucially hazardous in this treatment due to the possibility of brain infarction and an “arterial channel alteration” technique are illustrated. Lastly, it is noted that intra-arterial chemotherapy of these cancers is still on its way to being scientifically evaluated in comparison with intravenous chemotherapy with new drugs, which should be kept in mind by interventional radiologists, and that they should nevertheless make the utmost effort as the major player in this treatment.

Key words

  • Head and neck cancers
  • Intra-arterial chemotherapy
  • CDDP
  • Principles
  • Techniques


3. Intra-arterial Chemoradiation Therapy for Laryngeal and Pharyngeal Carcinomas :Clinical Neurovascular Anatomy and the Hemodynamic Balances in Head and Neck Carcinoma

Department of Radiology and Otolaryngology1), Kurume University School of Medicine
Norimitsu Tanaka, Toshi Abe, Yusuke Uchiyama, Kazuyuki Kojima
Gen Suzuki, Koji Ono1), Tadashi Nakashima1), Naofumi Hayabuchi

Laryngeal and pharyngeal carcinomas is the main target of intra-arterial infusion chemotherapy combined with concurrent radiation therapy, so called RADPLAT, because they are the most frequent sublocations in the head and neck carcinoma and organ preservation of the larynx and pharynx is of symbolic importance in this therapy.
Catheter related thrombo-embolic complications are a unique complication of RADPLAT and we have to perform it by preparing the neuro-endovascular setting to avoid such complications. It is reasonable to consider that RADPLAT for laryngo-pharyngeal carcinoma has a potentially higher risk of thrombo-embolic complications, because the superior thyroid artery, which is the main feeding artery of almost all laryngeal and some pharyngeal carcinomas, originates near the carotid bifurcation. Anatomical knowledge about the anastomoses of the branches of the external carotid artery to the internal carotid artery, vertebral artery and the ophthalmic artery is also essential to avoid neurovascular complications.
The idea of hemodynamic balances between the branches of the external carotid artery was originally proposed by Lasjaunias. In RADPLAT, the idea is also important to determinate the feeding arteries and delivery of anti-cancer agents. We present two cases of advanced laryngeal carcinoma and two cases of advanced pharyngeal carcinoma treated by RADPLAT. Schematic drawings of the important hemodynamic balances and anastomoses for RADPLAT area also presented.

Key words

  • Head and neck carcinoma
  • Intra-arterial chemotherapy
  • Chemoradiation therapy


4. Preoperative Intra-arterial Infusion Chemotherapy by Transfemoral Approach for Squamous Cell Carcinomas of the Oral Cavity

Department of Radiology, Miyakonojo Medical Association Hospital
Ichiro Ikushima
Department of Diagnostic Radiology, Oral and Maxillofacial Surgery1), Graduate School of Medical Sciences, Kumamoto University
Toshinori Hirai, Yasuyuki Yamashita, Masanori Shinohara1)
Department of Radiology, University of Occupational and Environmental Health School of Medicine
Yukunori Korogi

We performed preoperative intra-arterial infusion chemotherapy(PIC)according to a protocol in which drug distribution is evaluated with a angiography-computed tomography(angio-CT)system, and the chemotherapy is combined with medium-dose conformal radiation therapy(CRT). We demonstrated the factors that affect the midterm survival ratio, including local response, for squamous cell carcinomas of the oral cavity. The three-year survival ratio of the 40 cases was 67%. A good local response(III or IV)was achieved in 75% of the cases. The survival ratio of the good local response group was significantly better than that of the poor response group(p=0.04). Mode of invasion(p=0.03)and lymph node metastasis(p=0.01)were also predictive of survival. In the multivariable analysis of survival, however, no variables including good local response(p=0.12), were predictive. This regimen provides a good local histopathological response without any severe adverse effect.

Key words

  • Intra-arterial infusion chemotherapy
  • Squamous cell carcinoma
  • Oral cavity
  • Midterm survival


5. Superselective High-dose Cisplatin Infusion Therapy for Maxillary Cancer

Department of Diagnostic Radiology, Yamagata University Faculty of Medicine
Masafumi Kanoto, Atsuko Oda, Takaaki Hosoya

Treatment of maxillary cancer has been performed using trimodal therapy including surgical operation, systemic chemotherapy, and radiation. Recently, superselective high-dose cisplatin infusion therapy has been introduced for maxillary cancer instead of systemic chemotherapy. This therapy, which uses sodium thiosulfate to neutralize cisplatin, can enhance the intratumoral concentration of cisplatin markedly without systemic side effects. In maxillary cancer, lymph node metastasis and distant metastasis are rare. Consequently, local control of the maxillary tumor is the most important goal of therapy. We have experienced over 20 patients with advanced maxillary squamous cell carcinoma and have achieved a high rate of pathological complete response. The five-year survival rate and local control rate are also satisfactory. Additionally, we have never sacrificed the eyeball, even in T4 cases, since we began to use this therapy. All patients have been able to retain their eyesight. In this article, we introduce our procedures and discuss the results of superselective high-dose cisplatin infusion therapy for maxillary cancer.

Key words

  • Maxillary cancer
  • Cisplatin
  • Superselective infusion


6. Arterial Chemoradiotherapy for Locally Advanced Head and Neck Cancer-Role of Arterial Chemoradiotherapy-

Southern Tohoku Proton Center
Nobukazu Fuwa

To establish the clinical usefulness of arterial injection therapy in the treatment of head and neck cancer and other cancers, it must meet the following 4 conditions : 1) The treatment procedure is stable, with a high reproducibility and safety ; 2) The extent of arterial injection that covers the entire tumor can be confirmed ; 3) Anticancer agents appropriate for arterial injection therapy are selected, and the optimal dose is established ; 4) Arterial injection therapy is more advantageous than other treatments such as radiotherapy alone, chemoradiation therapy involving systemic chemotherapy and radiotherapy, and surgery.
Initially, concerning the stability of the treatment procedure, selective arterial injection had been performed since we employed the procedure in November 1999, the procedure has been stable without any drop-out cases.
Concerning the second condition, the extent of arterial injection has been confirmed by MRI flow-check method (MFCM). Concerning the third condition, the results of arterial injection therapy with CDDP were significantly better than the results of continuous arterial injection therapy with CBDCA,
Concerning the last condition, arterial injection therapy for advanced oral cavity cancer may potentially be more useful than other therapies.

Key words

  • Head and neck cancer
  • Intraarterial chemotherapy
  • Radiotherapy


Original Article

Quality of Life Assessment in Patients with Osteoporotic Vertebral Compression Fracture Treated by Percutaneous Vertebroplasty

Department of Radiology and Orthopedic Surgery1), St.Marianna University School of Medicine
Misako Yoshimatsu, Kenji Takizawa, Yasuo Nakajima, Shinjiro Sakaino
Yukihisa Ogawa, Kunihiro Yagihashi, Iwao Uejima, Kaoru Kitsukawa
Masakatsu Funakubo, Shin Matsuoka, Yutaka Sasao1)
Sports and Health Science, Daito Bunka University Faculty
Hiroki Sugimori

Percutaneous vertebroplasty (PVP) has been accepted as useful procedure for pain relief in patients with compression fractures due to osteoporosis. However, the most of studies have used visual analogue score for evaluation of the usefulness of PVP. However, the previous reports suggested that osteoporotic compression fractures deteriorated patient’s quality of life significantly. The purpose of our study was to assess the impact of PVP on the quality of life prospectively in patients with osteoporotic compression fractures.
After written informed consent was obtained, the visual analogue scale, the short-form (36-item) health survey(SF-36) scores, and Roland-Morris Disability Questionnaire (RDQ) score were measured at the time before PVP, a week, 1 month, 3 months, and 6 months after PVP. SF-36 measure mainly the systemic or non-specific QOL, and RDQ measures the disease specific QOL. The changes in outcome measure were analyzed by using analysis of variance. The score of SF-36 showed significant impairment of quality of life before PVP, but a significant improvement after PVP in both physical and mental status. The RDQ score also showed significant improvement up to 6 months after vertebroplasty.In conclusion, PVP contributes to the improvement of quality of life as well as pain relief.

Key words

  • PVP (Percutaneous vertebroplasty)
  • QOL
  • SF-36
  • Roland-Morris Disability
  • Osteoporosis

Case Report

A Case Report : Rupture of Idiopathic Internal Mammary Artery Aneurysm

Department of Cardiology and Cardiovascular Surgery1), Mito Saiseikai General Hospital
Yoshiro Chiba, Mayumi Shinonaga1), Minoru Murata, Hiroshi Fukunaga
Setsuo Kuraoka1), Shoh Tatebe1), Kouji Ohhira, Fumio Yamashita
Department of Diagnostic Imaging and Interventional Radiology,
Tokyo Women’s Medical University Yachiyo Medical Center
Joe Toda

Rupture of the internal mammary artery aneurysm is a very rare life-threatening situation. Although transcatheter intervention is one of the most effective therapies, precise diagnosis and immediate interventions are difficult to achieve in practice. We report a case of massive mediastinal hematoma caused by rupture of an idiopathic left internal mammary artery aneurysm that was treated successfully by transcatheter coil embolization.

Key words

  • Internal mammary artery aneurysm
  • Transcatheter coil embolism


Case Report

N-Butyl-cyanoacrylate Embolization of Bleeding from Colonic Angiodysplasia

Department of Radiology and Gastroenterology1), Toyonaka Municipal Hospital
Taku Yasumoto, Saki Nakata, Yoshiki Tsujii1), Seiichi Gouda, Masayuki Satou
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
Keigo Osuga

Colonic angiodysplasia is a rare vascular anomaly as a cause for lower gastrointestinal bleeding. We report a woman in her seventies with colonic bleeding induced by angiodysplasia of the ascending colon. The bleeding was uncontrollable by endoscopic hemostatic therapy, and transcatheter embolization was performed. NBCA-Lipiodol mixture (1 : 3 and 1 : 6) was selectively injected into each of the two feeding arteries without complications. The anemia and other symptoms remain improved during five-months follow-up. Recent reports showed the usefulness of transcatheter arterial embolization for bleeding from colonic angiodysplasia, however, few reports have referred to the efficacy of n-butyl cyanoacryate (NBCA) as the embolic material. NBCA embolization for the colonic angiodysplasia is a feasible and effective method.

Key words

  • Colon
  • Angiodysplasia
  • NBCA
  • TAE