Regional chemotherapy for recurrent squamous head and neck cancers through a saphenous vein interposition graft

Abstract

Regional chemotherapy for head and neck cancers is effective, but the intra-arterial catheter is not without problems. We interposed a segment of saphenous vein within the carotid system to administer chemotherapeutic agents percutaneously via the arterialized venous segment. From 1983 to 1990, saphenous vein interposition graft was performed after radiotherapy in 24 patients with persistent or recurrent squamous head and neck cancers, which were also considered unresectable. There was no operative mortality. Two patients developed thrombosed vein graft; another two had wound infection; and one patient had a neck hematoma. Cisplatin was administered percutaneously every week via the saphenous vein graft. The response rate was 64% (complete response, 23%; partial response, 41%), and the 5-year actuarial survival rate was 31%. The 1-year survival rates for patients with complete, partial, and no response were 80%, 33%, and 13%, respectively. Saphenous vein interposition graft is a safe and convenient way of delivering intra-arterial chemotherapy, and it provides significant palliation for patients with recurrent nonresectable squamous head and neck cancers after radiotherapy.