Single-agent and combination-drug regional chemotherapy for head and neck cancer using an implantable infusion pump

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Abstract
Chemotherapy delivered through angiographically placed catheters requires patient hospitalization, and is usually limited to short-term infusions. Treatment given through surgically placed catheters with external portable infusion pumps permits greater patient freedom and longer infusion durations. However, some patient restrictions remain, and thrombotic or infectious complications are common with long-term therapy. A totally implantable pump has allowed long-term intraarterial therapy in an outpatient population. Patient activity was unrestricted, and the complication rate has been low. This system has been used to deliver single-agent therapy with FUdR, dichloromethotrexate or bleomycin, and combination-drug treatment with cisplatin + FUdR or bleomycin + mitomycin C + dichloromethotrexate. The majority of patients have responded to at least one drug program. Seven of 14 patients who had pumps implanted over 1 year ago have received therapy for at least 1 year, and four patients have had functioning system for over 2 years. Systemic toxicity (except for nausea and vomiting with cisplatin) has been uncommon. Further clinical experience with these programs will be necessary to fully establish the objective response rate. However, the Infusaid Pump has proven safe, reliable and has high patient acceptance.