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Treatment of advanced squamous cell caricinomas of the head and neck with initial combination chemotheraphy prior to surgery and/or radiotheraphy: five-year survival data

Published online by Cambridge University Press:  29 June 2007

H. J. Shaw ,
L. A. Price  and
Bridget T. Hill
H. J. Shaw
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ.
L. A. Price
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ.
Bridget T. Hill
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ. Laboratory of Cellular Chemotherapy, Imperial Cancer Research Fund, London WC2A 3PX.
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Abstract

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20–30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in non-responders (54 per cent) p<0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p<0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p<0.01). Survival data are available for a mean follow-up time of 48 months (range 12–78 months). Chemotherapy responders have a longermedian survival than non-responders, 33 versus 20 months (p<0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p<0.001). Actuarial analyses indicate that at five years 46 percent of patients in complete remission are alive, compared with only 9 per cent with residual disease. Since chemotherapy responders are significantly more likely to achieve a complete remission than non-responders (p<0.05), objective response to this schedule of chemotherapy is a good prognostic sign.

Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 98 , Issue 1 , January 1984 , pp. 75 - 82
Copyright
Copyright © JLO (1984) Limited 1984

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References

Bezwoda, W. R., De Moor, N. G., and Derman, D. P. (1979) Treatment of advanced head and neck cancer by means of radiation therapy plus chemotherapy—a randomised trial. Medical and Paediatric Oncology, 6: 353–358.CrossRefGoogle ScholarPubMed
Brown, A. W., Blom, J., Butler, W. M., Garcia-Guerrero, G., Richardson, M. F., and Henderson, R. L. (1980) combination chemotherapy with vinblastine, bleomycin, and cis-diamine dichloroplatinum (II) in squamous cell carcinoma of the head and neck. Cancer, 45: 2830–2835.3.0.CO;2-#>CrossRefGoogle Scholar
Ervin, T. J., Kirkwood, J., Weichselbaum, R. R., Miller, D., Pitman, S. W., and Frei, E. III. (1981) Improved survival for patients with advanced carcinoma of the head and neck treated with methotrexate-leucovorin prior to definitive radiotherapy or surgery. Laryngoscope, 91: 1181–1190.CrossRefGoogle ScholarPubMed
Glick, J. H., Marcial, V., Richter, M., and Velez-Garcia, E. (1980) The adjuvant treatment of inoperable Stage III and IV epidermoid carcinoma of the head and neck with platinum and bleomycin infusions prior to definitive radiotherapy: An RTOG pilot study. Cancer, 46: 1919–1924.Google ScholarPubMed
Hong, W. K., Pennacchio, J., Shapshay, S., Vaughan, C., Katz, A., Bhutani, R., Bromer, R., Willett, B., and Strong, S. (1981) Adjuvant chemotherapy with cis-platinum and bleomycin infusion prior to definitive treatment for advanced Stage III and IV squamous cell head and neck carcinoma In Adjuvant Therapy of Cancer III. Eds. Salmon, S. E. and Jones, S. E., pp. 153–160. Grune and Stratton, New York.Google Scholar
Malaker, K., Robson, F., and Schipper, H. (1980) Combined modalities in the management of advanced head and neck cancers. Journal of Otolaryngology, 9: 24–30.Google ScholarPubMed
Peppard, S. B., Al-Sarraf, M., Powers, W. E., Loh, J. K., and Weaver, A. W. (1980) A combination of cis-platinum, oncovin and bleomycin (COB) prior to surgery and/or radiotherapy in advanced untreated epidermoid cancer of the head and neck. Laryngoscope, 90: 1273–1280.CrossRefGoogle ScholarPubMed
Perry, D. J., Weltz, M. D., Brown, A. W., Henderson, R. L., Neglia, W. J., and Berenberg, J. L. (1981) Adjuvant chemotherapy for advanced head and neck cancer. In Adjuvant Therapy of Cancer III. Eds. Salmon, S. E. and Jones, S. E., pp. 161–168. Grune and Stratton, New York.Google Scholar
Peto, R., Pike, M. C., Armitage, P., Breslo, N. E., Cox, D. R., Howard, S. V., Mantel, N., McPherson, K., Peto, J., and Smith, P. G. (1977) Design and analysis of randomised clinical trials requiring prolonged observation of each patient II: Analysis and examples. British Journal of Cancer, 35: 1–39.CrossRefGoogle ScholarPubMed
Price, L. A., Hill, B. T., Calvert, A. H., Shaw, H. J., and Hughes, K. B. (1975) Kinetically-based multiple drug treatment for advanced head and neck cancer. British Medical Journal, 3: 10–11.CrossRefGoogle ScholarPubMed
Price, L. A., Hill, B. T., Calvert, A. H., Dalley, V. M., Levene, A., Busby, E. R., Schachter, M., and Shaw, H. J. (1978) Improved results in combination chemotherapy of head and neck cancer using a kinetically-based approach: a randomised study with and without adriamycin. Oncology, 35: 26–28.CrossRefGoogle ScholarPubMed
Price, L. A., and Hill, B. T. (1980) Safe and effective combination chemotherapy for squamous cell carcinomas of the head and neck. Journal of Laryngology and Otology, 94: 89–90.CrossRefGoogle ScholarPubMed
Price, L. A., and Hill, B. T. (1981) Safe and effective combination chemotherapy without cis-platinum for squamous cell carcinomas of the head and neck. Cancer Treatment Reports, 65: (Supplement 1), 149–154.Google ScholarPubMed
Sargeant, R., and Deutsch, G. (1981) A preliminary report on the combination of initial chemotherapy and radiotherapy for advanced head and neck cancer. Journal of Laryngology and Otology, 95: 69–74.CrossRefGoogle Scholar
Shaw, H. J., Price, L. A., Hill, B. X., Calvert, A. H., Dalley, V. M., and Levene, A. (1978) A randomized combination chemotherapy trial, with and without adriamycin, in squamous cell carcinoma of the head and neck. Otolaryngology, 86: 845–850.CrossRefGoogle ScholarPubMed
Wittes, R., Heller, K., Randolph, V., Howard, J., Vallejo, A., Farr, H., Harrold, C., Gerold, F., Shah, J., Spiro, R., and Strong, E. (1979) Cis-dichlorodiamine platinum(II) based chemotherapy as initial. treatment of advanced head and neck cancer. Cancer Treatment Reports, 63: 1533–1538.Google Scholar