Three-year results of combined modality therapy in locally advanced, resectable squamous cell carcinoma of the head and neck

The role of adjuvant chemotherapy in the treatment of advanced head and neck cancer

The role of chemotherapy in the multidisciplinary treatment of advanced squamous cell carcinoma of the head and neck remains to be defined. Uncontrolled adjuvant studies integrating chemotherapy with local therapies utilizing a 'sequential' or 'simultaneous' strategy have indicated that high response rates to initial chemotherapy and high complete remission rates are achievable. Both these factors appear to predict for improved survival. Unfortunately results of randomized, controlled studies generally have not confirmed any major overall survival advantage. However, these trials clearly failed to utilize optimal therapies: suboptimal trials yield suboptimal results. Encouraging data from large uncontrolled studies have now provided critical information regarding optimal trial design; a) Since primary tumor site has proved a significant predictive factor for response to treatment and survival, future trials must include sufficient numbers of patients for detailed site-by-site analyses, and b) radical surgery may be omitted without compromising survival by using initial chemotherapy followed by radiotherapy for advanced laryngeal cancer.

Chemotherapy in head and neck cancer with bleomycin, cisplatinum, and methotrexate

Results of chemotherapy in head and neck cancers are reported with a regimen of cisplatinum, bleomycin and methotrexate. In 63 previously untreated patients, the overall response rate was 73%, including 13/63 CR and 33/63 PR. The response rate in 20 previously treated tumors was 20%. The chemotherapy protocol was well tolerated without severe complications. Initial chemotherapy as a third modality in addition to radiotherapy and/or surgery is discussed.

Chemotherapeutic management of head and neck cancer

The use of chemotherapy in patients with head and neck cancer is increasing. In patients with recurrent head and neck cancer, a large number of chemotherapeutic drugs have shown antitumor activity. These drugs are discussed, and factors which influence response rate and survival are examined. New agents and treatment, including specific agents for combination chemotherapy, are presented. There has been a search for new treatments or procedures in patients with previously untreated and locally advanced cancer of the head and neck. The results, including studies of combined modality therapy and chemotherapy after surgery, are discussed. Chemotherapy in tumor of the salivary glands is briefly discussed, followed by an examination of intra-arterial therapy.

The prognostic influence of induction chemotherapy on advanced head and neck carcinoma

We examined the influence of induction chemotherapy integrated with surgery and postoperative radiotherapy on 5-year treatment results of 107 patients suffering from advanced head and neck carcinomas. The chemotherapy regimen consisted of one to three cycles of a combination of cisplatin, methotrexate and bleomycin. The overall response rate to induction chemotherapy was 58% with a 26% complete response rate. Using actuarial life tables, survival was 44% for all patients. The initial tumor stages were found to be predictive for patients' responses to chemotherapy as well as for their survivals. The overall response rate was 65% for T-3 tumors vs 29% for T-4 tumors. Five-year survival was 54% for T-3 vs 24% for T-4 tumors. The other predictive factor for survival was response to chemotherapy. Five-year survival was 73% for those patients achieving a complete response vs 17%-37% for patients with any residual disease after drug treatment. Since a favorable response to chemotherapy was strongly associated with a lesser T-stage as well as with significantly better survival of patients in our study, we conclude that induction chemotherapy may best benefit those patients with smaller tumors. Our findings show that a complete response to chemotherapy can also serve as a good prognostic sign, although an a priori better prognosis is still associated with patients who have smaller tumors.

The effect of chemotherapeutic agents on human oral squamous cell carcinoma transplanted to nude mice: a histologic study

Clearly differentiated squamous cell carcinomas were transplanted to the backs of nude mice; tumor cells of a human tongue carcinoma cell line were used. Animals bearing tumors that measured at least 4 mm in diameter were treated with either methotrexate (MTX), cis-diamminedichloroplatinum II (CDDP) or bleomycin intraperitoneally for 5 days. Histologic evaluation of tumors obtained 24 hours after the last injection revealed degenerative and necrotic morphology in all treatment groups. The histologic alterations were observed prior to any clinical evidence of tumor shrinkage. The most impressive changes were found in CDDP-treated tumors, with creation of large pseudocysts containing necrotic material and cell debris. Pseudocyst formation was less obvious in MTX-treated animals and was absent in bleomycin-treated tumors. Drug treatment had no obvious influence on the keratinization in tumors. The findings suggest that the nude mouse model may be useful for the histologic determination of drug-induced effects on tumors in human beings.

Nutritional and immunological investigations in head and neck cancer patients before and after therapy

We studied the nutritional and immunological states of 20 patients with advanced head and neck carcinomas. Treatment included chemotherapy with methotrexate, cis-platinum and bleomycin prior to operation and radiotherapy. Nutritional and immunological parameters were examined before and after each therapy given. Most of these parameters decreased during chemotherapy. However, while we found that nutrition improved or normalized by the end of the primary tumor treatment, immunologic parameters failed to change significantly.

Cisplatin-induced ototoxicity: audiometric findings and experimental cochlear pathology

Twenty-four (48%) out of a group of 50 patients treated with one to three single doses of cisplatin compound (cis-DDP), at a dosage of 60 mg/m2 body surface, were found to have deterioration of post-treatment pure tone audiometric threshold levels. Statistical analysis of pre- and post-treatment hearing losses by means of the paired t-test, however, did not show any significant hearing loss associated with cis-DDP-toxicity, nor could hearing loss following treatment be correlated to ages of the patients, pre-treatment hearing impairments, specific frequencies, or the number of treatment courses given. In contrast, cochlear damage was studied in the guinea pig model by daily administration of high cumulative doses of cis-DDP, and was found to be dose-dependent and selectively restricted to the outer hair cells of the inner ear and corresponding nerve fibers. Hair cell degeneration was most severe in the basal turn of the cochlea, and progressed in an apical direction so that the cells in the first row were the most affected.