AJR:181, July 2003 253 A Novel Intraarterial Chemotherapy Using Paclitaxel in Albumin N anoparticles to Treat Advanced Squamous Cell Carcinoma of the Tongue: Preliminar y Findings O BJECT IVE. The purpose of our study was to evaluate the effectiveness of intraarterial in- fusion of paclitaxel incorporated into human albumin nanoparticles for use as induction che- motherapy before definitive treatment of advanced squamous cell carcinoma of the tongue. SU BJECT S AN D MET H O D S. Twenty-three previously untreated patients (age range, 27–75 years) who had carcinoma of the tongue (stage T3–T4, any N) received intraarterial therapy with paclitaxel incorporated into albumin nanoparticles delivered by transfemoral catheterization into the external carotid artery (10 patients), selectively into the lingual artery (12 patients), or into a faciolingual trunk (1 patient). Each patient received two to four infu- sions, with a 3-week interval between infusions. The dose administered was 230 mg/m 2 in eight patients, 180 mg/m 2 in six patients, and 150 mg/m 2 in nine patients. Sixteen patients un- derwent surgery. Of these 16 patients, eight subsequently received radiotherapy, and three re- ceived a combination of chemotherapy and radiotherapy. Of the remaining seven patients, one received chemotherapy alone, four received radiotherapy alone, one received chemotherapy plus radiotherapy, and one refused any further treatment. RESU LT S. Sixty-seven infusions were performed successfully. Eighteen patients (78%) had a clinical and radiologic objective response (complete, 26%; partial, 52%). Three patients (13%) showed stable disease, and two (9%) showed disease progression. The four patients with complete clinical response who underwent surgery showed microscopic residual carcinoma measuring less than 1 mm in two patients, less than 5 mm in one patient, and less than 1 cm in one patient. The toxicities encountered were hematologic (grade 3) in two patients (8.6%) and neurologic (grade 4) in two patients (reversible paralysis of the facial nerve, 8.6%). Two catheter-related complications occurred: one reversible brachiofacial paralysis and one asymptomatic occlusion of the external carotid artery. CONCLUSION. Intraarterial infusion of paclitaxel in albumin nanoparticles proved re- producible and effective and deserves further investigation as induction chemotherapy before definitive treatment of advanced tumors of the tongue, with a view to organ preservation. quamous cell carcinoma involv- ing the region of the head and neck most often originates in the oral cavity [1], where the tongue and floor of the mouth are the most frequently affected sites. Carcinoma of the mobile tongue repre- sents approximately 20–50% of all tumors of the oral cavity, with 5500 new cases and 1900 deaths reported each year in the United States. The lateral margin of the middle third of the tongue is affected in 37.4% of patients and the anterior third is affected in the re- mainder. Primary tumors of the dorsal tongue are rare [2]. Squamous cell carci- noma of the base of the tongue represents virtually one half of all tumors of the oropharynx. Carcinoma in this location is particularly insidious, and most patients with cancer of the base of the tongue present with locally and regionally advanced disease as- sociated with a high frequency of lymph node metastases. Approximately 35% of squamous cell carcinomas of the base of the tongue are classified as stage T3–T4 [3]. Treating tumors of the tongue can cause a significant functional deficit. Therefore, various therapeutic modalities must be considered, alone or in combination. Combined therapy is virtually the rule for patients with advanced dis- ease [4]. At present, stage T3–T4 tumors of the tongue are generally treated by radical surgery followed by radiotherapy. This strategy is prac- Bruno Damascelli 1 Gian Luigi Patelli 1 Rodolfo Lanocita 1 Giuseppe Di Tolla 1 Laura Francesca Frigerio 1 Alfonso Marchianò 1 Francesco Garbagnati 1 Carlo Spreafico 1 Vladimira Tichà 1 Caroline Regna Gladin 1 Mauro Palazzi 2 Flavio Crippa 3 Cesare Oldini 4 Stefano Calò 4 Alberto Bonaccorsi 4 Franco Mattavelli 5 Luigi Costa 5 Luigi Mariani 6 Giulio Cantù 5 Received October 22, 2002; accepted after revision December 17, 2002. Partially supported by research grants from Associazione Italiana per la Ricerca sul Cancro and from Lega Italiana per la Lotta contro i Tumori, and partially supported by licensee for ABI-007, ACS Dobfar, M ilano 20067, Italy. 1 Department of Radiology, Istituto Nazionale Tumori, Via Venezian, 1, Milano 20133, Italy. Address correspondence to B. Damascelli. 2 Department of Radiotherapy, Istituto Nazionale Tumori, M ilano 20133, Italy. 3 Department of Nuclear Medicine, Istituto Nazionale Tumori, Milano 20133, Italy. 4 Department of Head and Neck Surgery, Ospedale di Lodi, Lodi 26900, Italy 5 Department of Head and Neck Surgery, Istituto Nazionale Tumori, Milano 20133, Italy. 6 Department of Statistics and Biometry, Istituto Nazionale Tumori, Milano 20133, Italy. AJR 2003;181:253–260 0361–803X/03/1811–253 © American Roentgen Ray Society S