Organ preservation treatment of locally advanced cancer of the laryngopharynx using regional intra-arterial chemotherapy in a patient with solitary kidney

Abstract

Introduction. Chemoradiation therapy with a competitive regimen allows to avoid laryngectomy and increase patients’ quality of life. However, it’s highly toxic and this limits the use of this approach in patients with severe concomitant disorders. The alternative to systemic chemotherapy is infusion of high doses of chemotherapy drugs directly into a vessel supplying the tumor through a microcatheter.The study objective is to present a clinical case of using intra-arterial chemotherapy for treatment of locally advanced laryngopharyngeal cancer in a patient with a solitary functioning kidney. Materials and methods. Patient K., 55 years old, applied to the Head and Neck Tumors Clinical of the N.N. Blokhin National Medical Research Center of Oncology with laryngopharyngeal cancer and bilateral metastases in the lymph nodes (T3N2M0, stage IV). Use of systemic chemotherapy for this patient was limited because he had only 1 functional kidney. Three (3) courses of intra-arterial chemotherapy with docetaxel and cisplatin 60 mg/m2 (with detoxification with sodium thiosulfate) and subsequent radiation therapy, systemic infusion of 5-fluorouracil were performed.Results. The main side effect of the treatment was edema of the pharyngeal and laryngeal mucosa but without severe respiratory distress. The symptoms were corrected with inhalations of oxygen-hydrocortisone mixture. Laboratory and instrumental control during treatment didn’t show any deterioration of the state of the solitary functioning kidney.Conclusion. Regional intra-arterial chemotherapy demonstrated a satisfactory effect in a patient with severe concomitant pathology and absolute counterindications for systemic chemotherapy.

Keywords

• метастазирующий рак гортаноглотки
• внутриартериальная химиотерапия
• системная химиотерапия
• токсичность
• противопоказания