Intra-arterial chemotherapy for bleeding head and neck tumors: a single-center experience

Advanced-stage head and neck cancers are associated with high morbidity and mortality, often requiring complex therapeutic interventions. In cases of tumor-associated hemorrhage, intra-arterial (IA) chemotherapy combined with embolization offers a potential treatment strategy. This study assesses the safety and efficacy of this approach in a cohort of patients with bleeding head and neck malignancies.

A retrospective case series of five patients with advanced head and neck cancers who underwent IA chemoembolization between November 2023 and August 2024 is presented. Tumors included oropharyngeal squamous cell carcinoma and sinonasal undifferentiated carcinoma. IA chemotherapy (cisplatin or carboplatin) was administered via selective catheterization of tumor-feeding vessels. Tumor response was measured using three-dimensional (3D) volumetric analysis, and clinical outcomes were evaluated for bleeding control, disease progression, and complications.

All the patients achieved local tumor control, with tumor volume reductions ranging from 29% to 84% and a mean reduction of 66%. No rebleeding was observed at treated sites over a mean follow-up period of 8 months. All patients had an objective response at the treated site, and one patient showed disease progression on the contralateral side. No neurologic complications occurred. Complications included acute kidney injury in two patients (mitigated by adjusted hydration protocols) and flap necrosis in one patient.

IA chemotherapy with embolization appears to be a safe and effective method for managing bleeding in advanced head and neck cancers. The combination offers local tumor control and mitigates the risk of rebleeding, although larger studies are needed to confirm its role in clinical practice.