Induction chemotherapy with a new regimen alternating cisplatin, fluorouracil with mitomycin, hydroxyurea and bleomycin in carcinomas of nasopharynx or other sites of the head and neck region

Abstract

Sixty-six patients with locally advanced (Stages III and IV) carcinoma of the head and neck were treated with three cycles of induction chemotherapy, consisting of cisplatin, fluorouracil (FU) infusion, bleomycin, mitomycin, and hydroxyurea, followed by radiotherapy and/or surgery. There were 48 men and 18 women with a median age of 55 years (range, 18 to 75 years) and Karnofsky performance status of 80 (range, 40 to 90). Primary site was nasopharynx (28 patients), followed by larynx (12) and others (26). Forty-one (62%) patients were presented with Stage IV disease. The response rate to induction chemotherapy was 27% complete response, 50% partial response, 20% stable disease, and 3% progressive disease. There was no significant difference in response rate between patients with cancer of nasopharynx or other sites (P greater than 0.1). Survival was 61% at 24 months. Patients with cancer of nasopharynx had a better survival than those with other primaries (P = 0.033). Toxicities from chemotherapy included alopecia (73%), nausea/vomiting (66%), leukopenia (54%), stomatitis (36%), anemia (32%), thrombocytopenia (16%), and diarrhea (9%). Grade IV toxicity was not observed. Induction chemotherapy with this new regimen resulted in a high response rate but may not be superior to cisplatin and FU alone. It can be safely combined with radiotherapy as a potentially curative therapy in squamous cell carcinoma of the head and neck. Chemotherapy followed by radiation therapy may yield survival similar to radical surgery in laryngeal and other head and neck cancers.

Frontotemporal and dopaminergic control of idea generation and creative drive

“…Compared with studies on adjuvant chemotherapy, Phase II trials regarding induction chemotherapy described better patient tolerance and treatment compliance, as well as a high locoregional response of 72–100% 13, 16–20. Despite these promising results, none of the five randomized trials we studied demonstrated an overall survival advantage for all disease stages with this approach compared with RT alone (Table 2).…”

High rate of clinical complete response to weekly outpatient neoadjuvant chemotherapy in oral carcinoma patients using a new regimen of cisplatin, 5-fluorouracil, and bleomycin alternating with methotrexate and epirubicin

“…Postradiation or postoperative adjuvant chemotherapy seldom is tried because compromised vasculature, caused by radiation change or ablative surgery, will reduce drug penetration and the effectiveness of chemotherapy. The majority of clinical trials involve either neoadjuvant or concomitant chemotherapy for advanced SCCHN 3–6, 9–45. In general, the disadvantages of neoadjuvant chemotherapy include delayed primary treatment in nonresponders, refusal of further curative therapy in responders, triggering of accelerated repopulation of surviving clonogens,48 and cross‐resistance to further radiotherapy.…”

“…SCCHN refers to a heterogeneous population of patients with a primary tumor arising from the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, nasal cavity, paranasal sinus, etc. There are substantial discrepancies in terms of treatment outcome between the various anatomic subsites 17, 40, 42. Second, it has been well established that tumor cell heterogeneity exists in fresh tumor biopsies and long term cell culture lines.…”

“…Oncologists have sought to improve local control and survival by combining chemotherapy with standard treatment in patients with advanced solid tumors 7–10. Both neoadjuvant chemotherapy (before surgery or radiotherapy) and concomitant chemotherapy (with radiotherapy) for head and neck tumors have been studied extensively during recent years 3–6, 9–45. However, there still is great controversy regarding the optimal timing, dosage, and contribution of chemotherapy to increase curability.…”

Long‐term survival data and prognostic factors of a complete response to chemotherapy in patients with head and neck cancer treated with platinum‐based induction chemotherapy: A hellenic co‐operative oncology group study

“…From August 1984 to May 1991, 154 patients with locally advanced HNC were entered in 3 consecutive phase II trials [20][21][22]. Eligibility criteria were the following: histologically confirmed locally advanced non-metastatic (Mo) HNC, measurable or evaluable disease, normal hepatic and renal functions, platelets > 100,00/l, leukocytes >4,000/l, performance status (PS) >40 of Karnofsky's scale, age <75 years, absence of active ischemic heart disease, no prior therapy except a biopsy procedure, and a witnessed informed consent according to our institutional policies.…”