Induction Chemotherapy in Primary Resectable Head and Neck Tumors - A Prospective Randomized Trial

Volling, P.; Schröder, M.; Rp, Müller; Ebeling, O.; Quirin, R; Stennert, E.

doi:10.3892/ijo.4.4.909

Cited by 8 publications

(6 citation statements)

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“…Considering the fact that IA chemotherapy mainly has a local effect due to pharmacokinetics (Tegeder et al, 2003), neoadjuvant usage in patients with the small tumour stages 1 and 2 who had no clinical evidence of nodal disease would be most logical. Volling et al (1994Volling et al ( , 1999 conducted a prospective randomised trial on primary systemic chemotherapy with cisplatin and 5-fluorouracil. This internationally less known trial could demonstrate that especially patients with smaller resectable carcinomas of the tonsils and the floor of mouth benefited from this neoadjuvant treatment.…”

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confidence: 99%

Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results

Kovács

2004

Br J Cancer

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Intra-arterial (IA) chemotherapy for curative treatment of head and neck cancer experienced a revival in the last decade. Mainly, it was used in concurrent combination with radiation in organ-preserving settings. The modern method of transfemoral approach for catheterisation, superselective perfusion of the tumour-feeding vessel, and high-dose (150 mg m À2 ) administration of cisplatin with parallel systemic neutralisation with sodium thiosulphate (9 g m À2 ) made preoperative usage feasible. The present paper presents the results of a pilot study on a population of 52 patients with resectable stage 1 -4 carcinomas of the oral cavity and the oropharynx, who were treated with one cycle of preoperative IA chemotherapy executed as mentioned above and radical surgery. There have been no interventional complications of IA chemotherapy, and acute side effects have been low. One tracheotomy had to be carried out due to swelling. The overall clinical local response has been 69%. There was no interference with surgery, which was carried out 3 -4 weeks later. Pathological complete remission was assessed in 25%. The mean observation time was 3 years. A 3-year overall and disease-free survival was 82 and 69%, respectively, and at 5 years 77 and 59%, respectively. Survival results were compared to a treatment-dependent prognosis index for the same population. As a conclusion, it can be stated that IA high-dose chemotherapy with cisplatin and systemic neutralisation in a neoadjuvant setting should be considered a feasible, safe, and effective treatment modality for resectable oral and oropharyngeal cancer. The low toxicity of this local chemotherapy recommends usage especially in stage 1 -2 patients. The potential of survival benefit as indicated by the comparison to the prognosis index should be controlled in a randomised study.

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confidence: 99%

Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results

Kovács

2004

Br J Cancer

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“…Response criteria, technique (physical examination and/or imaging), and effect of response assessment are summarized in Table 1. 2,9,10,12,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] In the majority of studies, response to induction chemotherapy was assessed by clinical examination, sometimes combined with CT. However, the utilization of endoscopy for objective tumor evaluation has not been fully validated.…”

Section: Response Assessment In Randomized Clinical Trialsmentioning

confidence: 99%

“…Recently, a meta‐analysis on induction chemotherapy in patients with resectable HNSCC was performed by Ma et al From this meta‐analysis, all full articles were selected for review of the response assessment of induction chemotherapy. Response criteria, technique (physical examination and/or imaging), and effect of response assessment are summarized in Table . In the majority of studies, response to induction chemotherapy was assessed by clinical examination, sometimes combined with CT.…”

Section: Introductionmentioning

confidence: 99%

Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond

et al. 2017

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Significant correlations between the response to induction chemotherapy and success of subsequent radiotherapy have been reported and suggest that the response to induction chemotherapy is able to predict a response to radiotherapy. Therefore, induction chemotherapy may be used to tailor the treatment plan to the individual patient with head and neck cancer: following the planned subsequent (chemo)radiation schedule, planning a radiation dose boost, or reassessing the modality of treatment (eg, upfront surgery). Findings from reported trials suggest room for improvement in clinical response assessment after induction chemotherapy, but an optimal method has yet to be identified. Historically, indices of treatment efficacy in solid tumors have been based solely on systematic assessment of tumor size. However, functional imaging (eg, fluorodeoxyglucose‐positron emission tomography (FDG‐PET) potentially provides an earlier indication of response to treatment than conventional imaging techniques. More advanced imaging techniques are still in an exploratory phase and are not ready for use in clinical practice.

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“…1484 participants were pooled in the ICT group whereas the control group had 1388 patients for the metaanalysis. 14 RCTs compared the addition of ICT to surgery with/without radiotherapy [20][21][22][23][24][25][26][27][28][29][30][31][32][33] , 10 against radiotherapy alone 18,25,26,[33][34][35][36][37][38][39] , one for CCRT 19 , and one study 40 did not specify the standard therapy given. Regarding ICT regimen, twelve trials evaluated a Cisplatin-5-Fluorouracil containing protocol 20,21,25,26,32,[36][37][38][40][41][42] , eight used a Cisplatin-Bleomycin containing protocol 22, 24,28,33,34,36,38,39 , two administered Bleomycin and Vinicristine 23,27 , one included Cisplatin, Bleomycin and 5-Fluorouracil (5-FU)…”

Section: Description Of Included Studies and Data Analysismentioning

confidence: 99%

“…RCTs 18,22,26,27,29,30,41 were considered low risk of bias. However many studies had insufficient descriptions on how allocations into treatment groups during randomization was performed.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Induction chemotherapy for squamous cell carcinomas of the oral cavity: A cumulative meta-analysis

Lau

Yang

et al. 2016

Oral Oncology

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27 randomized trials were included for analysis (n=2872 patients). The shortest median follow-up was 15months whereas the longest was 11.5years. ICT does not improve OS (HR=0.947, 95% CI 0.85-1.05, p=0.318), DFS (RR=1.05, 95% CI 0.92-1.21, p=0.462) and DM (RR=0.626, CI 95% 0.361-1.086, p=0.096) compared to locoregional treatment alone. However, there was a significant improvement to LRR (RR=0.778, 95% CI 0.622-0.972, p=0.027). There is no evidence ICT improves survival outcomes for OSCC patients. However, ICT reduces locoregional recurrence of OSCC, which may need further verification.

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Induction Chemotherapy in Primary Resectable Head and Neck Tumors - A Prospective Randomized Trial

Cited by 8 publications

References 0 publications

Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results

Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results

Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond

Induction chemotherapy for squamous cell carcinomas of the oral cavity: A cumulative meta-analysis

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