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Alterations of Intratumoral Pharmacokinetics of 5-Fluorouracil in Head and Neck Carcinoma during Simultaneous Radiochemotherapy¹

Research Program Radiological Diagnostics and Therapy, German Cancer Research Center (Deutsches Krebsforschungszentrum) [H-P. S., M. B., P. B., I. Z., M. V. K., G. v. K.], and Departments of Otolaryngology, Section Oncology [A. D., B. V., P. W., H. W.], and Radiation Therapy, Radiological Clinic [V. R., M. W.], University of Heidelberg, 69120 Heidelberg, Germany

The kinetics of local drug uptake and metabolism of the anticancer drug 5-fluorouracil (5-FU) has been monitored by means of ¹⁹F nuclear magnetic resonance spectroscopy in 17 patients with neck tumors during concurrent radiochemotherapy. All of the patients underwent an accelerated hyperfractionated, concomitant-boost radiochemotherapy with 5-FU [600 or 1000 mg/m² of body surface (b.s.)] and carboplatin (70 mg/m² of b.s.). Serial ¹⁹F nuclear magnetic resonance spectra were obtained during and after the administration of 5-FU in a 1.5-T scanner with the use of a 5-cm diameter surface coil positioned on a cervical lymph node metastasis. Examinations were performed at day 1 of therapy and, in 13 patients, also after 43.5 Gy of irradiation at day 1 of the second chemotherapy cycle. Resonances of 5-FU and the catabolites 5,6-dihydro-5-fluorouracil (DHFU) and -fluoro-ß-alanine (FBAL) were resolved in the tumor spectra. The median of the 5-FU and FBAL levels was significantly higher (more than 2-fold) at the second compared with the first examination, whereas the level of DHFU did not change. This effect could indicate an increased delivery of 5-FU into the interstitial space of the tumor in the course of the combined treatment, which would result in an enhanced exposure of the tumor cells to the drug. A potential mechanism for synergy between radio- and chemotherapy is discussed, but alternative mechanisms are also being considered. The findings indicate that a method is available to rationally address the design of dosing schedules in concurrent therapy regimens.

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