Introduction Head and neck tumors can provide challenging pathologies given their location in relation to essential structures, their potential for hypervascularity, and difficulty in management of recurrent or advanced cancer. Here we review the utility and current indications for intra-arterial embolization in the management of these complex patients.

Methods A comprehensive literature review was performed using PubMed on intra-arterial embolization in head and neck cancer.

Discussion Intra-arterial embolization is primarily utilized in two methods in head and neck cancer: treatment of hypervascular tumors and chemoembolization of advanced cancers. The most common and well-established use of intra-arterial embolization is for head and neck paragangliomas. These are hypervascular tumors that have long been treated pre-operatively with embolization to decrease the morbidity and mortality of surgery with a well-established safety profile. Since the Society of NeuroInterventional Surgery 2012 Head, neck, and brain tumor embolization guidelines¹ this has been a pivotal aspect of these patients‘ treatment plan and has been repeatedly shown to have technical success rates of 90+% with minimal complications.^2–4 Advances in arterial embolization continue with utilization of newer agents, including success with direct injection of Squid liquid embolic agent.⁵

Embolization is also commonly used as a salvage therapy to control bleeding in patients with advanced or recurrent head and neck cancer. In a retrospective review, Shetty et al show that intra-arterial salvage embolization in patients with unresectable tumors is safe and provides adequate control of bleeding with only 3/26 (11.5%) having recurrent bleeding post-procedure.⁶ Others have demonstrated the use of endovascular embolization in palliative patients with high success rates and the ability of patients to remain home with loved ones prior to this death.⁷

More recently, tumor chemoembolization has grown in popularity with advances in intra-arterial catheters for super-selective delivery. Attempts have been made over the years to utilize this technique in advanced head and neck cancers, including attempts to use carboplatin microcapsules,⁸ cisplatin crystals,⁹ and more recently with drug-eluting embolic agents.^{10 11} Drug-eluting embolic agents mark the next step in the progression of intra-arterial treatment of head and neck tumors and provide a promising new subset of patients. Studies have shown objective response rates in recurrent and advanced head and neck cancers from 25-60% and disease control rates of 69-100% with minimal adverse effects, showing superior efficacy and a more favorable safety profile compared to conventional chemoembolization.

Conclusions Intra-arterial embolization of head and neck cancers is safe and efficacious to treat both hypervascular tumors and for chemoembolization of complicated advanced cancers.

References

1. Duffis EJ, et al. DOI: 10.1136/neurintsurg-2012-010350

2. De Marini P, et al. DOI: 10.1016/j.clinimag.2021.08.014

3. Michelozzi C, et al. DOI: 10.1136/neurintsurg-2014-011582

4. Rangel-Castilla L, et al. DOI: 10.1136/neurintsurg-2012-010542

5. Pedicelli A, et al. DOI: 10.1177/1591019919895882

6. Shetty, et al. doi: 10.1007/s00405-020-06505-7

7. Sesterhenn AM, et al. DOI: 10.1017/S0022215105003178

8. Tomura N, et al. Doi:10.1177/02841851960371P111

9. Kovacs AF, Truowski B. doi: 10.1016/s1368-8375(01)00088-4

10. Bi Y, et al. doi: 10.1016/j.jvir.2022.05.002

11. Gao F, et al. doi: 10.3389/fsurg.2022.938305

Disclosures S. Capone: None. B. Patel: None.