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Abstract:

Introduction: treatment of patients with primary malignant neoplasms (PMN) of head and neck remains an unsolved problem. About 70% of neoplasms are unresectable, and one-year mortality rate reaches 90%.

Aim: was to demonstrate possibilities of using the technique of isolated chemoperfusion of head and neck (ICPHN) developed by us in the experiment.

Material and methods: ICPHN was performed using the method of extracorporeal membrane oxygenation (ECMO) on two non-human primates (hamadryas baboons), 20 kg males, 12–14 years old. The open version of intervention involved performing sternotomy, cannulation of brachiocephalic arteries (BCA) and superior vena cava (SVC) with their subsequent clamping after starting parallel ECMO. The endovascular version was made by overlapping the BCA and SVC with transfemorally inserted balloon catheters. Cannulation for ECMO was performed percutaneously through the axillary artery and vein. Perfusion was carried out for 30 minutes with a chemotherapy (CP) drug carboplatin at a dose of 150 mg injected immediately into the circuit.

Results: both procedures were carried out successfully with good immediate and long-term (30 days of follow-up) results. After 10, 20 and 30 minutes from the moment of CP injection into the isolated circuit, its content in the circuit was 7-10 times, 3-3,5 times and 4-4,5 times exceeding the concentration in the systemic circulation, respectively. During the perioperative period, vital functions and laboratory parameters were within normal limits. No complications associated with both procedures were observed. All animals quickly recovered from anesthesia without signs of neurological disorders.

Conclusions: the use of isolated chemoperfusion of head and neck with carboplatin in the experiment is feasible and safe. In the head and neck contour, the concentration of CP is observed, 3-5 times higher than in the systemic circulation, and that allows a more pronounced targeted effect on tumor. Taking into account the minimally invasiveness and repeatability of the procedure, the use of endovascular isolated chemoperfusion of head and neck is more promising.

 

 

References

 

1.     Vleeschouwer SD. Glioblastoma. Brisbane. Codon Publications. 2017; 678.

2.     Maghami E. Multidisciplinary Care of the head and neck cancer patient. Springer International Publishing. 2018; 282.

3.     Srinivasan VM, Lang FF, Chen SR, et al. Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors. J Neurointerv Surg. 2020; 12(2): 197-203.

4.     Newton HB. Intra-arterial chemotherapy of primary brain tumors. Curr Treat Options Oncol. 2005; 6(6): 519-530.

5.     Klopp CT, Alford TG, Bateman J, et al. Fractionated intra-arterial chemotherapy with methyl bis amine hydrochloride; a preliminary report. Ann Surg. 1950; 4: 811-832.

6.     Creech O, Krementz ET, Ryan RF, et al. Chemotherapy of сancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958; 4: 616-632.

7.     Woodhall B, Hall K, Mahaley S, et. al. Chemotherapy of brain cancer: experimental and clinical studies in localized hypothermic perfusion. Ann Surg. 1959; 4: 640-651.

8.     Feind CR, Herter F, Markowitz A. Improvements in isolation head perfusion. Am J Surg. 1963; 5: 777-782.

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