Since 1995, we have conducted intra-arterial chemotherapy for advanced head and neck cancer to improve prognosis and to preserve significant organs.
Novel approaches have increased the organ preservation rate in spite of frequent distant metastasis. Cimetidine, a kind of H2-blocker, inhibits the development of E-selectin on vascular endothelial cells, and contributes to a decrease in distant metastasis and improvement in prognosis for digestive cancer.
Objective: To evaluate the decrease in distant metastasis and its relation to the administration of Cimetidine when used concurrently with intra-arterial chemotherapy for advanced head and neck cancer.
Method and Patients: 153 patients treated by intra-arterial chemotherapy for stage IV head and neck cancer from May 2000 to December 2008 were divided into two groups: the Cimetidine group (114 patients) and the non-Cimetidine group (39 patients). Analysis of distant metastasis between the two groups was performed retrospectively. Intra-arterial chemotherapy was administered at 150 mg/m² of CDDP four times per week. In the Cimetidine group, 800 mg of Cimetidine was administered for a period of more than one year prior to treatment. FDG-PET was performed 2 months after the treatment. Pulmonary CT was performed every 6 months, and chest X-ray examination was conducted every three months.
Results: The median period of observation was 45 months for the Cimetidine group and 64 months for the non-Cimetidine group (p < 0.05). Distant metastasis was detected in 10 out of the 39 cases in the non-Cimetidine group and in 6 out of the 114 cases in the Cimetidine group (p < 0.05). Metastatic organs consisted of: 8 cases in lungs, 5 cases in bones, 2 cases in brain, and 1 case in retroperitoneum. The mean time of distant metastasis after treatment was 6.9 months (2-20).
Conclusion: Combined intra-arterial chemotherapy and Cimetidine is useful for the treatment of advanced head and neck cancer due to increased loco-regional control and decreased distant metastasis.