Phase I trial of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

The aim of this study was to evaluate the efficacy and toxicity of a concurrent chemoradiotherapy using docetaxel, cisplatin and 5-fluorouracil (5-FU) (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In total, 19 patients with previously untreated stage III–IV SCCHN were entered onto this trial. Patients received two cycles of chemotherapy. Cycles were repeated every 4 weeks. The starting doses (dose level 1) were docetaxel 60 mg m⁻², cisplatin 70 mg m⁻², and 5-day continuous infusion of 5-FU 600 mg m⁻² day⁻¹. Radiation was targeted to begin on the first day of chemotherapy, day 1. The total radiation dose to the primary tumour site and neck lymph nodes was between 63.0 and 74.0 Gy. At least three patients were examined at each dose level before advancing to the next level. The maximum-tolerated dose (MTD) of this regimen was docetaxel 60 mg m⁻², cisplatin 60 mg m⁻² and 5-FU 600 mg m⁻² day⁻¹. The main toxicities were mucositis (grade 3 and 4, 79%), leukocytopenia (grade 3 and 4, 53%), neutropenia (grade 3 and 4, 42%), anaemia (grade 3, 16%), liver dysfunction (grade 3, 11%) and renal dysfunction (grade 2, 11%). The overall response rate was 100%, including 84% complete responses (CRs). This concurrent chemoradiotherapy with TPF was safe and well tolerated. The high CR rate justifies further evaluation of this chemoradiotherapy modality in advanced SCCHN patients.

[The benefit of head rotation on pharyngoesophageal dysphagia from three cases of paraganglioma in the parapharyngeal space]

The benefit of head rotation to the affected side is indicated during swallowing in patients complaining of dysphagia with unilateral pharyngeal palsy and/or laryngeal palsy. We experienced three cases of severe dysphagia after operations for giant paragangliomas (two vagal paraganglioma and one carotid body tumor) in the parapharyngeal space. During operation, the transmandibular transpterygoid approaches were applied to ensure better surgical views, and tracheostomy was performed to keep the airway open after operation. In each case, dysphagia during the pharyngeal stage of swallowing was significantly improved with rehabilitation using of this head rotation. We believe that rather than forbid oral intake, using an active bolus with head rotation is important for cases where dysphagia in the pharyngeal stage of swallowing is present with unilateral pharyngeal and/or laryngeal palsy. Repetitive swallowing exercises are important to reacquire the complicated movement of swallowing. Additionally, an active bolus flowing into the pyriform sinus on the healthy side will prevent a relaxation disorder of the cricopharyngeal muscle on that side. Furthermore, compensatory movement of the arytenoid on the healthy side improves dysphagia. We emphasize the usefulness of head rotation during swallowing rehabilitation for dysphagia with unilateral pharyngeal and/or laryngeal palsy in spite of its simplicity.

[The expression of ICAM-1 on head and neck squamous cell carcinoma cell lines]

Intercellular adhesion molecule-1 (ICAM-1) is one of the cell adhesion molecules. This molecule is a glycoprotein of about 90 KDa belonging to the immunoglobulin (Ig) superfamily and is widely expressed by hematopoietic and non-hematopoietic cells which play a role in the immune system. ICAM-1 is also a ligand or counter-receptor for the leukocyte integrin lymphocyte-function associated antigen-1 (LFA-1). We investigated the expression of ICAM-1 on the surfaces of cells from fifteen head and neck squamous carcinoma cell lines and the modulation of ICAM-1 expression by IFN-gamma, using an immunohistochemical stain. We categorized four types of stain degree. (-): < 10% of cells positive (+/-): 10-40% of cells positive (+): < 40-70% of cells positive (++): > 70% of cells positive Four cell lines showed (-) type. Three cell lines: (+/-). One cell line: (+). Seven cell lines: (++). The primary site of cell lines and the degree of ICAM-1 expression were not detectable. Connection between pathological differentiation and the degreed expression were not apparent, either. IFN-gamma up-regulated the degree of ICAM-1. All cell lines, when stimulated by IFN-gamma, showed (++) type.