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Laryngorhinootologie 2021; 100(04): 278-284
DOI: 10.1055/a-1279-0018
Originalarbeit

Eine Frage der Zeit und Dosierung – intraarterielle Chemotherapie beim Oropharynxkarzinom

It’s a matter of time and dosage – intra arterial chemotherapy for carcinoma of the oropharynx
Karl Reinhard Aigner 
  Surgical Oncology, Medias Klinikum Burghausen, Germany
,
Emir Selak
  Surgical Oncology, Medias Klinikum Burghausen, Germany
,
Sabine Gailhofer
  Surgical Oncology, Medias Klinikum Burghausen, Germany
,
Kornelia Aigner
  Surgical Oncology, Medias Klinikum Burghausen, Germany
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Zusammenfassung

Einleitung Patienten mit Kopf-Hals-Tumoren erreichen durch die Standardtherapie gute Ansprechraten. Die Lebensqualität ist aber unter Radiochemotherapie oft sehr beeinträchtigt und Hauptgrund der hohen Suizidrate. In dieser Studie wird über die Behandlung von fortgeschrittenen Oropharynxkarzinomen des Stadiums IV mit intraarterieller Kurzzeit-Chemotherapie berichtet.

Methoden 55 Patienten mit progredienten, inzwischen inoperablen Oropharynxkarzinomen des Stadiums IVA (n = 44), IVB (n = 4) und IVC (n = 7) wurden mit intraarterieller Kurzzeit-Chemotherapie (IAC) behandelt. Die IAC wurde niedrigdosiert entweder über einen Angiokatheter oder einen implantierten intraarteriellen Portkatheter über einen Zeitraum von 7–12 Minuten infundiert. Ausgeprägte Tumormassen, eine hohe Anzahl an metastasierten Lymphknoten oder Lungenmetastasen wurden mit zusätzlicher isolierter Thoraxperfusion behandelt.

Ergebnis Unterschiedliche Überlebenszeiten wurden erreicht, je nach Vorbehandlung der Patienten. Die 1-, 2- und 3-Jahres-Überlebensraten lagen bei 76 %, 54 % und 35 % für nicht vorbestrahlte Tumoren und bei 40 %, 7 % und 7 % für vorbestrahlte Tumoren. Besonders gute Überlebenszeiten hatte die Untergruppe der zuvor behandelten, aber nicht bestrahlten Patienten mit Rezidiven (n = 8), welche eine mediane Überlebenszeit von 33,5 Monaten erreichten. Demgegenüber betrug die mediane Überlebenszeit der Patienten mit bestrahlten und rezidivierten Tumoren 8,2 Monate. Tracheostomien und Ernährungssonden wurden in allen Fällen vermieden.

Diskussion Randomisierte klinische Studien sind nötig, um die Ergebnisse zu belegen. Die Gabe von kleinen Dosierungen in das begrenzte Volumen der Tumorregion erzeugt hohe Konzentrationen am Wirkort und damit eine verstärkte Wirkung.

Abstract

Introduction Advanced head and neck cancer (HNC) patients have good response rates with radiochemotherapy. However, quality of life is often severely affected and the main reason for high rates of suicide. For a deliberately milder treatment, there is an option to selectively treat the tumor region with chemotherapy. This study reports on the treatment of oropharyngeal carcinoma with intra arterial short-term infusion.

Methods 55 patients, suffering from inoperable carcinoma of the oropharynx have been treated with intra-arterial short-term infusion chemotherapy via angiocatheters or implanted arterial port catheters. Infusion time of 7 to 12 minutes. Patients with high tumor load or lung metastases had additional treatment of isolated thoracic perfusion.

Results Divergent overall survival rates have been noted depending on the pretreatment of the patients. One-, two-, and three-year survival rates of 76 %, 54 % and 35 % for patients without prior irradiation and 40 %, 7 % und 7 % for priorly irradiated patients have been observed. Particularly long overall survival rates have been observed for the subgroup of patients with pretreatment but without irradiation suffering from relapsed cancer, who reached median survival rates of 33.5 months. In contrast, the median survival of irradiated patients suffering from recurrent cancer was 8.2 months. Tracheostomy and tube feeding could be avoided in any case.

Discussion Randomized clinical trials are necessary to support these results. However, small dosages can generate high concentrations in limited volumes and therefore have an increased effect while keeping side effects low.

Schlüsselwörter

regionale Chemotherapie - Kopf-Hals-Tumoren - Lebensqualität - Radiochemotherapie - Kurzzeit-Infusion - Oropharynxkarzinom - Toxizität - Cisplatin - Plattenepithelkarzinom - intraarterielle Infusion

Key words

regional chemotherapy - quality of life - head and neck cancer - radiochemotherapy - short-term infusion - oropharyngeal carcinoma


Publication History

Received: 08 May 2020

Accepted: 25 September 2020

Article published online:
21 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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