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

颈转移是影响舌癌预后的重要因素。我们的目标是建立淋巴化疗靶向颈部转移的舌癌（cT 3 N2 bM 0）患者使用动脉化疗。方法对舌癌（cT 3 N2 bM 0）患者行动脉内化疗作为新辅助化疗。化疗一周后，患者接受手术治疗。顺铂通过动脉内化疗给药。在手术开始时，向供血动脉给予5 mg吲哚菁绿色（ICG）。在手术前一天，使用ICG荧光成像和常规的肿瘤内注射放射性方法检测转移淋巴结。结果CDDP在有转移和无转移SLN中的平均浓度分别为2.35 μg/g和1.08 μg/g（p = 0.034）。在27个转移性淋巴结中，24个（89%）通过ICG荧光成像确定;然而，由于舌癌的传入神经阻滞，只有18个（67%）通过常规局部注射方法确定。（p = 0.043）。在22个可测量的转移性淋巴结中，14个应答（部分应答），8个无应答（疾病稳定）。结论CDDP在转移淋巴结中的浓度明显高于非转移淋巴结。这种新型的给药系统是可行的淋巴化疗靶向转移淋巴结的舌癌患者。

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.