Therapeutic efficacy of selective intra-arterial chemoradiotherapy with docetaxel and nedaplatin for fixed bulky nodal disease in head and neck cancer of unknown primary

Multi-modality imaging for precise intra-arterial delivery of mRNA, AAVs, and antibodies to the head and neck area in mice

The intra-arterial (IA) route offers several advantages over systemic infusion for drug administration, enabling selective delivery to target organs, achieving higher local drug concentrations, and minimizing off-target toxicity. However, its clinical adoption remains limited, with only a few IA-based therapies routinely used in patients. While IA chemotherapy for head and neck cancer has been explored, results remain conflicting. With the rapid rise of biologics, we investigated the efficacy of IA delivery for three key classes-mRNA, adeno-associated viruses (AAVs), and monoclonal antibodies-targeting the head and neck region in mice. We infused firefly luciferase-encoding mRNA (Luc mRNA), adeno-associated virus encoding luciferase (AAV9-Luc), and radiolabeled anti-VEGF monoclonal antibody (bevacizumab) via the external carotid artery and compared results with IV administration. Bioluminescence imaging revealed robust expression of Luc mRNA and AAV9-Luc in the head and neck region following IA infusion, with negligible expression after IV delivery. qPCR analysis further confirmed significantly higher Luc mRNA expression in targeted tissues (salivary gland, temporal muscle, and tongue) following IA administration. In contrast, after IV administration, Luc mRNA expression was detected only in the salivary gland at a level 100-fold lower, with no detectable expression in the temporal muscle or tongue. For quantitative assessment of antibody biodistribution, we radiolabeled bevacizumab with Zirconium-89 (89Zr) and performed positron emission tomography (PET) imaging following IA vs. IV infusion. PET imaging revealed significantly increased uptake of bevacizumab in the neck following IA delivery (mean standardized uptake values: 0.65 vs. 0.29, IA vs. IV), corroborated by ex vivo biodistribution analysis, which confirmed higher accumulation of bevacizumab in targeted structures of the head and neck. In summary, our findings demonstrate the feasibility and superiority of the IA route for the delivery of biologics to the head and neck territory. This study provides compelling evidence supporting the translational potential of IA administration as a highly effective strategy for precise biologic delivery in head and neck disorders and cancers.

Usefulness of arterial spin labeling MR angiography as preprocedural mapping for the intra-arterial chemotherapy in patients with maxillary sinus cancer: A case report

Arterial spin labeling (ASL) magnetic resonance angiography (MRA) (ASL-MRA) is a newly developed method that can visualize small arteries, particularly those running tortuously and inferiorly at slow flow rates. It provides excellent visualization of the external carotid artery system, with superior performance in visualizing the middle meningeal artery (MMA) compared to that of computed tomography angiography (CTA). Here, we report a case of maxillary sinus carcinoma in which ASL-MRA revealed an ipsilateral ophthalmic artery originating from the MMA that was not visualized on CTA. Volume rendering or maximum intensity projection images of CTA may fail to depict small arteries that run close to bony structures, including anomalies of the MMA originating from the external carotid artery system. In such cases, ASL-MRA may serve as a useful tool to easily visualize the arteries.

The effect of arterial spin labeling MR angiography (ASL-MRA) in visualizing the branches of external carotid artery

This study aimed to assess the performance of arterial-spin labeling MRA (ASL-MRA) for visualizing the external carotid artery (ECA) branches in comparison with time-of-flight MRA (TOF-MRA) and CT angiography (CTA). We retrospectively selected 31 consecutive patients, who underwent both MRAs and CTA, prior to the intra-arterial chemoradiotherapy (IACRT) for head and neck cancer. Four patients underwent IACRT bilaterally, so we analyzed 35 ECAs. Pseudo-continuous, three-dimensional ASL using a turbo field echo sequence was acquired. For the TOF-MRA and CTA, clinically used parameters were applied. Two observers evaluated each ECA branch with reference to the angiogram at the IACRT, using five-point scale, in consensus. Friedman test for multiple comparisons was applied. ASL-MRA and CTA better visualized the superior thyroid, lingual, facial, submental, transverse facial, and internal maxillary arteries (IMAs) better than TOF-MRA (p < 0.05). In addition, CTA was superior to ASL-MRA in visualizing only submental artery among these arteries (p = 0.0005). Alternatively, the ASL-MRA was superior for visualizing the middle meningeal artery (MMA) and IMA, compared to the CTA (p = 0.0001 and 0.0007, respectively). ASL-MRA was superior to the TOF-MRA and similar to the CTA in visualizing most of ECA branches. Furthermore, ASL-MRA can better visualize the periphery of MMA and IMA than CTA.

Chitosomes Loaded with Docetaxel as a Promising Drug Delivery System to Laryngeal Cancer Cells: An In Vitro Cytotoxic Study

Current delivery of chemotherapy, either intra-venous or intra-arterial, remains suboptimal for patients with head and neck tumors. The free form of chemotherapy drugs, such as docetaxel, has non-specific tissue targeting and poor solubility in blood that deters treatment efficacy. Upon reaching the tumors, these drugs can also be easily washed away by the interstitial fluids. Liposomes have been used as nanocarriers to enhance docetaxel bioavailability. However, they are affected by potential interstitial dislodging due to insufficient intratumoral permeability and retention capabilities. Here, we developed and characterized docetaxel-loaded anionic nanoliposomes coated with a layer of mucoadhesive chitosan (chitosomes) for the application of chemotherapy drug delivery. The anionic liposomes were 99.4 ± 1.5 nm in diameter with a zeta potential of -26 ± 2.0 mV. The chitosan coating increased the liposome size to 120 ± 2.2 nm and the surface charge to 24.8 ± 2.6 mV. Chitosome formation was confirmed via FTIR spectroscopy and mucoadhesive analysis with anionic mucin dispersions. Blank liposomes and chitosomes showed no cytotoxic effect on human laryngeal stromal and cancer cells. Chitosomes were also internalized into the cytoplasm of human laryngeal cancer cells, indicating effective nanocarrier delivery. A higher cytotoxicity (p < 0.05) of docetaxel-loaded chitosomes towards human laryngeal cancer cells was observed compared to human stromal cells and control treatments. No hemolytic effect was observed on human red blood cells after a 3 h exposure, proving the proposed intra-arterial administration. Our in vitro results supported the potential of docetaxel-loaded chitosomes for locoregional chemotherapy delivery to laryngeal cancer cells.

Anatomical Targeting of Anticancer Drugs to Solid Tumors Using Specific Administration Routes: Review

Despite remarkable recent progress in developing anti-cancer agents, outcomes of patients with solid tumors remain unsatisfactory. In general, anti-cancer drugs are systemically administered through peripheral veins and delivered throughout the body. The major problem with systemic chemotherapy is insufficient uptake of intravenous (IV) drugs by targeted tumor tissue. Although dose escalation and treatment intensification have been attempted in order to increase regional concentrations of anti-tumor drugs, these approaches have produced only marginal benefits in terms of patient outcomes, while often damaging healthy organs. To overcome this problem, local administration of anti-cancer agents can yield markedly higher drug concentrations in tumor tissue with less systemic toxicity. This strategy is most commonly used for liver and brain tumors, as well as pleural or peritoneal malignancies. Although the concept is theoretically reasonable, survival benefits are still limited. This review summarizes clinical results and problems and discusses future directions of regional cancer therapy with local administration of chemotherapeutants.