Combination therapy for head and neck cancer with CTL induced in vitro and low dose of anticancer drugs followed by iradiation.

对22例上颌窦癌（MSC）患者采用低剂量化疗和过继免疫联合治疗2个周期。采集外周血单个核细胞（PBMC）后第4、5天，将导管逆行插入肿瘤供血动脉。次日动脉内注射顺铂或卡铂，剂量分别为20 mg/体、100 mg/体，5-氟尿嘧啶250 mg/体，连续5天。在低剂量化疗期间，利用同种异体间充质干细胞和白细胞介素-2从自体PBMC诱导细胞毒性T淋巴细胞（CTL）。在完成低剂量化疗后，这些体外诱导的CTL被输注回动脉内给患者，并通过CT扫描评估其效果。根据三种联合治疗的评价，所有患者均行40次放射治疗，再行手术治疗。在22例患者中，分别有1例和14例对化学免疫治疗表现出完全缓解（CR）和部分缓解（PR）。共有13例（55%）患者在三种联合治疗后出现临床CR。在这13例临床CR患者中，有11例在组织学上未发现残留肿瘤，需要手术治疗，且功能和形态学上均无明显牺牲。两例组织学上的PR患者尽管术后进行了额外的照射，但仍发生了复发。9例PR患者均行除眶术1例，其余3例和5例分别行上颌切除术（保留眶内容物）和Denker手术（同时保留眶内容物和上颚），7例复发。Kaplan-Meier生存率显示患者5年生存率约为60%。三种联合治疗为大约一半的MSC患者带来了疗效和良好的生活质量。

We applied 2 cycles of combination therapy with low dose chemotherapy and adoptive immunotherapy for 22 patients with maxillary sinus carcinoma (MSC). On 4th or 5th day after collection of peripheral blood mononuclear cells (PBMC), cannula were inserted retrogradely into tumor feeding artery. On the following day, cisplatin or carboplatin was injected intraarterially at 20 mg/body, 100 mg/body, respectively and 250 mg/body of 5-fluorouracil were administered on the subsequent 5 consecutive days. During the low dose chemotherapy, cytotoxic T lymphocyte (CTL) were induced from autologous PBMC using allogeneic MSC cell line and interleukin-2. After the completion of low dose chemotherapy, these in vitro-induced CTL were infused back intra-arterially to the patient, and the effects were estimated by CT scans. Subsequently, all the patients received 40 Gy-radiotherapy and then surgery on the basis of the evaluation on the three combination therapy. Of 22 patients, one and fourteen showed complete response (CR) and partial response (PR), respectively, to the chemo-immunotherapy. A total of 13 patients (55%) showed clinical CR in response to the three combined therapy. No residual tumor was confirmed histollogically in eleven of these thirteen clinical CR patients and required surgery without pitiful functional and morphological sacrifices. The two histlological PR patients occurred recurrence despite additional post-operative irradiation. In 9 clinical PR patients, surgery including orbital exenteration was carried out for one patients and the other 3 and 5 patients received maxillectomy (preserved orbital content) and Denker's operation (preserved both orbital content and palate), respectively and 7 occurred recurrence. Kaplan-Meier survival rate showed that 5 year survival rate of these patients were approximately 60%. The three combination therapy brought curative effect and good quality of life to approximately half of MSC patients.