I want to describe my experience with a new procedure that delivers a highly concentrated dose of Cisplatin to the tumor site. It is my understanding that this treatment generally is effective when used in combination with radiation and thus is generally not being used when cancer reappears in an area that has already been radiated.
MY SITUATION. I am a 55 year old resident of Washington, D.C. I was diagnosed in August 1998 as having a primary tumor at base of tongue and secondary tumors in three lymph nodes on upper left side of neck. Despite being a non smoker and non drinker, I found myself with stage IV cancer. Initially, I was stunned, feeling that I would die in three months. That pity party lasted one week. Then I got down to fighting this thing.
TREATMENT OBJECTIVE. After much consultation and reading, I opted for the protocol at George Washington Uni. Hospital. The procedure seems to be primarily used for killing tumors in areas (e.g., base of tongue) where surgery would greatly impair bodily functions. It combines standard treatment (i.e., radiation, neck dissection, and systemic chemo) with a new procedure called Intra Arterial Infusion (IAI). Generally, IAI is used as the very first step in the treatment process. It either shrinks the tumor to a very small size or eliminates it.
In my case, the tongue tumor was reduced from the size of a half-dollar to the size of a pea after four infusions and was undetectable after six infusions. (Because I began radiation after the 4th infusion, the subsequent disappearance of the tumor cannot be entirely attributed to the IAI alone.) My surgeon (Dr. Wilson) tells me that some patients have started out with swollen tongues hanging out their mouths and, by the time they start radiation, find that their tongue tumors have been reduced to nearly nothing. GWU doctors report having good results over the past five years with approx. one hundred patients. Five year data are not yet available but GWU doctors are planning to release their results, probably next year. The best way to learn about the effectiveness is to simply call the doctors (I have phone numbers) and ask
PROCEDURE. A team of 5 persons (2 radiologists and 3 assistants) performed the IAI. They first inserted a catheter in one of my leg arteries at the groin area. Using X-rays and video monitors to observe the catheter, they worked this tube up various arterial pathways until it was at a branching point that supplied blood to both the tongue base and the lymph node area. The catheter was positioned carefully so that it could bath all the tumors with Cisplatin.
The radiologist chose a position that would release 75% of the Cisplatin to the tongue base and 25% to the lymph node area. To do so, he first did a trial run with dye. Because the dye shoots rapidly into the blood stream, the dye release was played back in slow motion on video monitors to ensure that placement was correct. In this way, the radiologist was able to deliver a dose of Cisplatin to my tongue base that is a thousand times what could be delivered to that area using systemic release (i.e., infusion into the arm).
I could tolerate the lethal dose of Cisplatin only because an antidote was released at the same time. It was released through a second catheter, which had been snaked up my veins to a position near the first catheter. The antidote neutralized most of the poison. The remaining poison, however, was sufficient to keep me in bed for five days (only one night in the hospital).
Because the IAI released a mega dose of poison only a few inches from my brain, success requires an expert radiologist who is well seasoned in positioning such catheters (Dr. Bank, in my case). It therefore is not surprising that only a few cancer centers are performing these infusions. My radiologist was Dr. Bank at GWU here in D.C.
I had six of these IAIs spread over two months. (Most patients, however, need only four IAIs.) I also had two months of radiation, followed by the neck dissection and then systemic infusion of Taxol, administered once every 3 weeks over a period of 3 months.
UNPUBLISHED RESULTS, REPORTED INFORMALLY, BY GW HOSPITAL IN JANUARY 2000:
Improving survival and simultaneously preserving organ integrity remain as challenges in the management of advanced (stage III and IV) squamous cell carcinoma of the head and neck. Since August 1994 we have utilized a treatment regimen consisting of four to six weekly intra-arterial infusions of cisplatin (150 mg/m2) targeted specifically to the tumor bed followed by radiation therapy.
To date, we have treated approximately 100 patients with this regimen; the 58 patients (44 men and 14 women) who have been followed at least 2 years (median follow up of 25 months) form the basis of this report. There were 42 previously untreated patients (4 Stage III and 38 Stage IV) and 16 previously treated patients with recurrent disease in this cohort. Response to treatment was determined by magnetic resonance imaging (MRI) and clinical examination.
Of the 42 previously untreated patients, 27 are alive and disease free, corresponding to a cure rate of 64.3%. The median follow up time for the previously untreated patients was 30 months. Of the patients with recurrent, previously treated carcinoma, there are 4 survivors, corresponding to a cure rate of 25%. The median follow up time for the recurrent, previously treated patients was 15.5 months.
Of note, there were no deaths or serious complications related to the treatment in either group. Only one patient required resection of the tumor site (via laryngectomy).
In conclusion, the combination of high-dose, intra-arterial cisplatin and radiation therapy is effective in improving survival and organ preservation rates in previously untreated, advanced squamous cell carcinoma of the head and neck.
INSURANCE COVERAGE. My insurance covered it. IAI generally is not considered experimental for insurance purposes because it is a new way of delivering an approved and well established drug, Cisplatin.
GWU CONTACTS: Dr. William Wilson (Head/Neck Surgeon), (202) 994-4008; Dr. Siegel (ENT) (202) 994-2911. Easiest to reach by phone is Hoang Nguyer (202) 994-2296. He assists patients having this IAI treatment and coordinates their appointments with various doctors.
AVAILABILITY ELSEWHERE. The IAI program at other cancer centers is somewhat different because IAI is given concurrently with radiation, not before. Principle investigators and centers are shown below. (List was revised 9-3-99.)
IOWA: Dr. W. Zhen, Univ. of Iowa
NASHVILLE: Dr. A. Cmelak, Vanderbilt Univ.
MEMPHIS: Dr. K. Thomas Robbins and Dr. J. Cantrell, Univ. of Tennessee, Dept. of Otolaryngology, 956 Court Avenue, Suite B226, Memphis TN 38163, (901) 448-5886, Fax# (901) 448-5120
MEMPHIS: Dr. S. Gregory, Baptist Cancer Institute, Baptist Memorial Hospital, Memphis, Tennessee, hospital: (901) 227-7465
SAN DIEGO: Dr. R. Weisman, Univ. of California at San Diego
SAN FRANCISCO: Dr. K. Fu, Univ. of California at San Francisco
VERMONT: Dr. P. Swift, Univ. of Vermont
VERMONT: Dr. P. Swift, Univ. of Vermont
VIRGINIA: Dr. G. Schechter, Eastern Virginia Medical Center
VIRGINIA: Dr. T. Rich, Univ. of Virginia
WASHINGTON: Dr. K. Hunt, Univ. of Washington