Development of a novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with head and neck cancer

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Introduction Neck metastasis is a significant prognostic factor of tongue cancer. Our goal is to establish lymphatic chemotherapy targeting neck metastases in patients with tongue cancer (cT3N2bM0) using intra-arterial chemotherapy. Methods Patients with tongue cancer (cT3N2bM0) were treated by intra-arterial chemotherapy as neoadjuvant chemotherapy. After a week of chemotherapy, patients underwent surgical treatment. CDDP was administered through Intra-arterial chemotherapy. At the beginning of surgery, 5 mg of indocyanine green (ICG) was administered to the feeding artery. Metastatic lymphnodes were detected using ICG fluorescence imaging and a conventionalradioactive method of intra-tumor injection a day before surgery. Results The mean CDDP concentrations in the metastasis and non-SLNs were 2.35 μg/g and 1.08 μg/g, respectively (p = 0.034). Of 27 metastatic nodes, 24 (89%) were identified by ICG fluorescence imaging; however, only 18 (67%) were identified by the conventional local injection method because of occlusion of afferent lymphatics from the tongue cancer. (p = 0.043). Of 22 measurable metastatic nodes, 14 responded (partial response) and 8 did not respond (stable disease). Apoptosis was detected in all metastatic nodes.Conclusion CDDP concentrations in metastatic nodes were significantly higher than those in non -SLNs. This novel drug-delivery system is feasible for lymphatic chemotherapy targeting metastatic nodes in patients with tongue cancer.