Long-lasting full remission after selective intra-arterial chemotherapy for recurrence of locally advanced oral mucosa carcinoma

Objective: To present the effectiveness of selective intra-arterial chemotherapy and chemoembolization for management of head and neck squamous cell carcinomas recurrence and long-lasting remission.

Material and methods: Patient 27 years old, with histologically verified squamous cell carcinoma of the oral mucosa
of III T2N1M0 had been treated by chemoradiation. Two courses of intravenous (IV) Cisplatin a dose of 100 mg/m2 were
performed and 3-D conformed radiotherapy by 2 Gy fractions x 1 time a day to a total dose of 40 Gy. Interruption of the
treatment was due to the development of radiation mucositis. After 2 additional courses of IV cisplatin 100 mg/m2 and
achievement of total radiation dose 70 Gy was marked the relapse. To eliminate growing residual tumor intra-arterial (IA)
chemotherapy and selective chemoembolization were applied.

Results: A reduction of the tumor size was marked soon after the first course of IA chemotherapy (Cisplatin 150 mg and
5-fluorourocyl 1000 mg) and embolization of the thyroid arterial branch with PVA particles. Cicatricial changes in the oral
cavity were noted after the second course of IA chemotherapy. After the fifth course of IA chemotherapy and consequential
chemoembolization of facial artery the tumor was eliminated and full remission was obtained. The relapse was not revealed
in follow up observation during 4 years. The objective result was confirmed by PET-CT.

Conclusion: The original technique of selective intra-arterial chemotherapy and chemoembolization combination is
an effective approach for residual squamous-cell head and neck carcinomas management after completed chemoradiation.
This approach could be a last-chose method to obtain long-lasting remission.