An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck.

Abstract

This study examines the role of combination chemotherapy with surgery and/or radiotherapy in the initial treatment of patients with advanced stage III and IV squamous-cell carcinoma of the head and neck (SCCHN). Two courses of initial (induction) cisplatin, bleomycin, and methotrexate with oral calcium leucovorin (PBM) were used with the principal intent of increasing the effectiveness of subsequent surgery and/or radiotherapy. Following induction chemotherapy and local treatment, disease-free patients who had responded to initial chemotherapy were entered into a randomized trial of adjuvant PBM. The response rates to induction PBM chemotherapy were a complete response (CR) rate of 26% and a partial response (PR) rate of 52%, for an overall response rate of 78%. A response to induction PBM was highly correlated with failure-free survival (P less than .0001). A Cox multistep regression analysis of potential prognostic factors was performed. After adjusting for the significant prognostic factors of performance status, initial tumor size, and primary tumor site, a response to induction chemotherapy remained independently associated with improved survival (P = .0002). The randomized trial of adjuvant chemotherapy demonstrated that such treatment significantly improved failure-free survival by decreasing local-regional failures. The benefit of adjuvant chemotherapy was particularly evident in patients who had a PR to induction chemotherapy (P = .01). The toxicity of this multidisciplinary approach was predictable and acceptable. Surgery and radiotherapy were not compromised by induction or adjuvant chemotherapy. Definitive evidence that chemotherapy can favorably influence survival awaits confirmation of these results by a randomized trial using a control arm of patients treated with conventional surgery and/or radiotherapy alone.

Randomized scheduling feasibility study of S-1 for adjuvant chemotherapy in advanced head and neck cancer

“…The regimen of adjuvant chemotherapy in randomized studies consisted of three courses of intravenous low-dose CDDP-based regimen every 6 weeks (Ervin et al, 1987), monthly intravenous CDDP (80 mg m À2 ) alone for 6 months (Jacobs and Makuch, 1990), three courses of intravenous CDDP (100 mg m À2 ) with 5-day continuous infusion of 5-FU at 1000 mg m À2 day À1 (Laramore et al, 1992) and 18 courses of intravenous methotrexate (250 mg m À2 ) followed by 5-FU (600 mg m À2 ) with leucovorin rescue over 6 months on an outpatient basis (Johnson et al, 1996). A few studies suggested survival benefits (Ervin et al, 1987;Johnson et al, 1996) and a decrease in the incidence of distant metastases with adjuvant chemotherapy (Jacobs and Makuch, 1990;Laramore et al, 1992). The Head and Neck Contracts Study group showed that adjuvant chemotherapy, while reducing distant metastases, does not improve survival significantly in the total of cases studied; however, a significant survival advantage with adjuvant chemotherapy was detected for oral cavity cancer and for N2 disease using a subset analysis (Jacobs and Makuch, 1990).…”

“…Adjuvant chemotherapy might be a one of the candidates. Several randomised trials of adjuvant (maintenance) chemotherapy in advanced SCCHN have been done (Ervin et al, 1987;Jacobs and Makuch, 1990;Laramore et al, 1992;Johnson et al, 1996). A few randomised trials regarding adjuvant chemotherapy reported the possibility of survival benefits (Ervin et al, 1987;Johnson et al, 1996).…”

Enhanced antitumor effect of RGD fiber-modified adenovirus for gene therapy of oral cancer

“…On reaching 60-100 mm 3 , the tumor nodules were injected, through a single needle pass, with a dose of 7.5Â10 8 particles of AxCAhIL2-F/ wt or AxCAhIL2 -F /RGD in 50 L of phosphate -buffered saline (PBS ) (six mice per group ). Bidimensional tumor measurements were taken every 3 days with calipers, and the tumor volume was calculated using the simplified formula for a rotational ellipsoid: 0.4 Â length 2 Â width.…”

“…In advanced disease (stages III and IV ), the 2 -year survival rate drops to as low as 30%. 1,3 Because of the poor outcome in advanced HNSCC, new treatment strategies are urgently required. One promising approach currently being investigated is based on gene therapy.…”

Cross-resistance of platinum derivatives in H-1R, a cisplatin-resistant cell line

“…Platinum analogues are key anticancer agents used in the chemotherapy of solid tumors, such as ovarian (24), advanced bladder carcinoma (25), testicular (26), head and neck (27)(28)(29) and lung carcinomas (30).…”