Chemotherapy of patients with recurrent head and neck cancer

Efficacy and safety of photodynamic therapy with temoporfin in curative treatment of recurrent carcinoma of the oral cavity and oropharynx

Therapeutic options for recurrent carcinoma of the upper aérodigestive tract (UADT) are limited. The prognosis of these tumours remains poor with significant rate of recurrence and a lower median survival time. Photodynamic therapy (PDT) is a relatively new therapeutic alternative which combines the use of a photosensitising agent and light to induce a cytotoxic effect on the tissues. This is a retrospective single-centre study carried out in patients with a recurrence of an oral cavity or oropharyngeal carcinoma or a second appearance of tumour in a previously irradiated area. There were no metastases in lymph nodes or other organs. Laser treatment was carried out 96 h after temoporfin (Foscan(®)) injection. In our series we had 14 cases with a complete response, 1 partial response. Overall survival at 1 year was 72 % and 36 % at 5 years. Disease-specific survival at 1 year was 82 % and 45 % at 5 years. Recurrence-free survival at 1 year was 52 % and 34 % at 5 years. Side effects mainly described are pain in the area of illumination, well controlled. PDT with Foscan(®) gives useful results in terms of survival and improvement in quality of life with few adverse events or severe complications. The fact that it has low toxicity and that treatment sessions can be repeated mean it should be considered in the therapeutic armamentarium for recurrent carcinoma of the UADT.

Plattenepithelkarzinome im Kopf-Hals-Bereich

INTRODUCTION

Photodynamic therapy (PDT) is a relatively new method of treating superficial tumours of the skin or mucous membranes. After the injection of a photosensitiser, the tumour area is exposed to non-thermal laser light. This causes a phototoxic reaction, producing oxygen radicals that destroy the tumour cells.

PATIENTS AND METHODS

From November 2004 to February 2006, a total of 24 patients with recurrent or secondary tumours after squamous cell carcinoma of the head and neck were treated with PDT at the German Armed Forces Hospital in Ulm after other treatment options had failed. Meta-tetrahydroxyphenyl chlorin (mTHPC), known under the trade name of Foscan, was used as the photosensitising agent.

RESULTS

Complete remission was observed in 12 patients (50%) and partial remission was seen in nine (37.5%). Three patients did not respond to treatment. The mean duration of overall survival was 305.7 days (+/-199.4) after completion of treatment. The mean duration of recurrence-free survival was 302.7 days (+/-144.9) for patients with complete remission. There were no serious complications.

CONCLUSIONS

Photodynamic therapy is an important treatment option for patients who develop recurrent or secondary tumours after squamous cell carcinoma of the upper aerodigestive tract and fail to respond to other treatments. In addition, PDT may play a role in the primary treatment of superficial tumours of the oral cavity, pharynx and larynx in the future.

Mitochondria as a critical target of the chemotheraputic agent cisplatin in head and neck cancer

Cisplatin is among the most important chemotherapeutic agents ever developed. It is a critical component of therapeutic regimens in a broad range of malignancies. However, more than a generation after its clinical introduction, the exact mechanism of cisplatin action on tumor cells is not fully defined. The preponderance of research over the last three decades has focused on cisplatin interactions with nuclear DNA which are felt to lead to apoptotic cell death in sensitive cells. However, recent data have shown that cisplatin may have important direct interactions with mitochondria which can induce apoptosis and may account for a significant portion of the clinical activity associated with this drug. These direct interactions between cisplatin and mitochondria may have critical implications for our understanding of this class of drugs and the development of new therapeutic agents.

mTHPC-mediated photodynamic therapy in patients with advanced, incurable head and neck cancer: a multicenter study of 128 patients

BACKGROUND

The aim of this multicenter study was to assess tumor response, clinical quality-of-life benefit, survival, and safety after treatment with mTHPC in patients with recurrent/refractory squamous cell carcinoma of the head and neck unsuccessfully treated or unsuitable for treatment with conventional modalities.

METHODS

One hundred twenty-eight patients were treated with mTHPC followed, 96 hours later, by illumination of the tumor surface with 652-nm laser light. Tumor response was assessed with WHO criteria and tumor mass reduction from baseline. Clinical quality-of-life benefit was based on the University of Washington Quality-of-Life questionnaire.

RESULTS

By use of WHO criteria, 38% of evaluable patients achieved an overall tumor response, and 16% achieved a complete tumor response. Forty-three percent of assessable lesions achieved 100% tumor mass reduction, and 58% achieved 50% or greater tumor mass reduction. Fifty-three percent of evaluable patients experienced significant clinical quality-of-life benefit. Subset analyses revealed two subgroups in which significantly better responses were seen in patients with tumors 10 mm or less in depth and patients with fully illuminated lesions. In patients fulfilling both categories, overall tumor response was 54%, complete tumor response was 30%, and 61% demonstrated significant clinical quality-of-life benefit. Median survival was significantly better in responders. No major toxicities were detected.

CONCLUSIONS

Patients with advanced cancer of the head and neck, who have exhausted other treatment options, can achieve significant clinical benefit and improvement in quality of life with mTHPC.

Multimodal intensification therapy for previously untreated advanced resectable squamous cell carcinoma of the oral cavity, oropharynx, or hypopharynx

BACKGROUND

An intensified treatment regimen for previously untreated Stage III and IV resectable oral cavity, oropharyngeal, or hypopharyngeal squamous cell carcinoma was analyzed to assess disease control, patient compliance, and toxicity.

METHODS

Forty three patients with previously untreated, advanced, resectable squamous cell carcinoma of the oral cavity, oropharynx, or hypopharynx were enrolled in a prospective Phase II institutional clinical trial at a tertiary care comprehensive cancer center. This regimen was a continuum of multimodal treatment in a contracted time interval. It included preoperative slightly accelerated hyperfractionated radiotherapy with concurrent cisplatin, followed immediately with surgery and intraoperative radiotherapy, and completed with early postoperative weekly paclitaxel (beginning on Day 6 after surgery), two additional cisplatin cycles, and concurrent once daily radiotherapy beginning on Day 28 after surgery.

RESULTS

The current trial was designed to reduce the toxicity of the systemic therapy while maintaining or improving locoregional/distant disease control and patient compliance. There were 43 patients enrolled, and the range of time at risk was 2.6 to 24.7 months (median, 14.6 months). Of the 43 registered patients, 43 were evaluable. The locoregional (100%) and systemic (93%) disease control rates were excellent, with low rates of patient noncompliance (21%) and reduced levels of toxicity.

CONCLUSIONS

An intensive treatment regimen that improves disease control and treatment compliance is clearly feasible for this patient population. Future plans include modifications to continue to reduce toxicity and expansion to a multi-center Phase II trial to determine if the single institutional results can be duplicated.