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Microvascular reconstruction after intra-arterial chemotherapy with concomitant radiation
Joseph Valentino1, W Brian Helton, Raman Unnikrishnan
1Department of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Summary
Microvascular reconstruction after HYPERRADPLAT treatment for head and neck cancer leads to high rates of arterial complications. This suggests a delayed arterial injury from this specific chemoradiation regimen.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Microvascular reconstruction is successful after radiotherapy.
- Outcomes after chemoradiation are less documented.
- HYPERRADPLAT is a specific regimen of hyperfractionated radiation and intra-arterial chemotherapy.
Purpose of the Study:
- To evaluate microvascular reconstruction outcomes in patients treated with HYPERRADPLAT.
- To test the hypothesis that delayed progressive vessel injury occurs after HYPERRADPLAT.
Main Methods:
- Retrospective case series with chart review.
- Study conducted at a tertiary referral academic medical center.
- Included 8 patients who underwent free tissue transfer after HYPERRADPLAT for advanced head and neck squamous cell carcinoma.
Main Results:
- 50% of patients experienced wound breakdown or fistula.
- 50% of patients had arterial failure due to anastomosis thrombosis.
- Two free flaps could not be salvaged.
Conclusions:
- Microvascular reconstruction after HYPERRADPLAT is associated with significant arterial complications.
- HYPERRADPLAT may cause delayed, progressive injury to recipient arteries.
- Further research is needed to understand this effect in conventional chemoradiation settings.
