ABSTRACT
BACKGROUND: Many studies have shown gemcitabine and cisplatin are radiosensitizers. Concurrent chemoradiation seems to be an efficient approach for treatment of advanced head and neck cancer (HNC), but toxicity is significant. OBJECTIVE: To evaluate safety and explore efficacy of alternating chemotherapy with gemcitabine and cisplatin concurrent with radiotherapy in patients with advanced non-metastatic HNC. PATIENTS AND METHODS: Twenty-eight patients diagnosed with advanced Squamous Cell Carcinomas of the Head and Neck (SCCHN) in stages III (28%), IVa (36%), and IVb (36%) were treated with gemcitabine: 100mg/m(2) alternating with cisplatin: 50mg/m(2) concurrent with radiotherapy at doses of 2 Gy/day until completing 70 Gy. While awaiting for concurrent treatment, eleven patients received induction chemotherapy with cisplatin: 100mg/m(2) and 5-FU: 1000 mg/m(2). Toxicity, especially in relation to mucositis, xerostomy, dysphagia, leucopenia and radiodermitis was evaluated. RESULTS: 5-year progression-free survival was 27.8 ± 17.2% (CI-95: 0-61.5) and overall survival was 55.9 ± 11% (CI: 34.4-77.5). Overall response rate was 93%; complete response was 64.3% and partial response was 28.6%. Extensive surgery for primary site was avoided in 19 patients (70.4%). Grade 3-4 adverse events were mucositis (46.4%), leucopenia (14.2%), dysphagia (25%), xerostomy (10.7%) and radiodermitis (3.6%). Response rates and toxicity were not significantly different among those patients with and without induction chemotherapy, but survival was higher in patients receiving induction. CONCLUSIONS: Gemcitabine alternating with cisplatin concurrent with radiotherapy is an active and safe treatment that deserves further study.
Subject(s)
Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Chemoradiotherapy/methods , Cisplatin/therapeutic use , Deoxycytidine/analogs & derivatives , Head and Neck Neoplasms/drug therapy , Radiation-Sensitizing Agents/therapeutic use , Adult , Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/radiotherapy , Cisplatin/administration & dosage , Deglutition Disorders/chemically induced , Deoxycytidine/therapeutic use , Disease Progression , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Head and Neck Neoplasms/radiotherapy , Humans , Induction Chemotherapy/methods , Leukopenia/chemically induced , Male , Middle Aged , Neoplasm Staging , Radiodermatitis/etiology , Radiotherapy Dosage , Remission Induction , Safety , Stomatitis/chemically induced , Survival Rate , Treatment Outcome , Xerostomia/chemically induced , GemcitabineABSTRACT
We present 4 case studies of patients with Down's syndrome and testicular germ-cell cancer, treated with conventional methods at the National Cancer Institute of Mexico, with similar outcomes as patients without this syndrome. There are several reports of testicular cancer arising in patients with Down's syndrome worldwide, mainly from Caucasian populations. We discuss some theories about the association and the possible increase of incidence (AU)
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