ABSTRACT
We surveyed neuro-oncologists regarding patients treated with temozolomide for at least 12 cycles or 12 months. Patients receiving first-line temozolomide for a median 13 cycles had a median progression-free survival (PFS) of 14 months. Patients with recurrent disease receiving a median 14 cycles had a median PFS of 15.5 months. A small percentage of patients experienced grade III to IV toxicity. These results suggest that long-term treatment with temozolomide is feasible and well tolerated.
Subject(s)
Brain Neoplasms/drug therapy , Brain Neoplasms/mortality , Dacarbazine/analogs & derivatives , Glioma/drug therapy , Glioma/mortality , Risk Assessment/methods , Adolescent , Adult , Aged , Antineoplastic Agents, Alkylating/administration & dosage , Dacarbazine/administration & dosage , Disease-Free Survival , Feasibility Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Risk Factors , Survival Analysis , Survival Rate , Temozolomide , Treatment OutcomeABSTRACT
PURPOSE: The radiotherapeutic possibilities are limited for patients with a recurrent or second head and neck cancer if the patient was already irradiated in the first therapy. In the presented study we investigated the changes of this situation due to the usage of amifostine in the case of re-irradiation (simultaneous radio-chemotherapy). PATIENTS AND METHODS: Between 1995 and 1997 we treated 14 patients with a recurrent or second malignancy of the head and neck region by a simultaneous radio-chemotherapy (20 x 1.5 Gy, Carboplatin 70 mg/m2 BSA on days 1 to 5 and 16 to 20, 500 mg amifostine prior to every carboplatin infusion). Six out of 14 patients got an additional brachytherapy (10 to 15 Gy) to increase the local dose because of a residual tumor. In 4 cases the treatment was an adjunctive one, following the surgical tumor debulking. RESULTS: We have seen 3 complete remissions (21.4%), and 8 partial remissions (57.1%). The median time of observation is 13 months now. Three out of 14 patients died, 2 because of the tumor. Hematological toxicities: side effects Grade 2 WHO were seen only in 1 patient. Acute non-hematological toxicities: mucositis Grade 0/1 in 7 patients, mucositis Grade 2 in 7 patients, dysphagia Grade 0/1 in 9 patients, dysphagia Grade 2 in 5 patients, xerostomia Grade 1 in 9 patients, xerostomia Grade 2 in 3 patients. We registrated only 1 serious late toxicity due to radio-chemotherapy: 4 months after brachytherapy a patient (with laryngectomy) developed a submental fistula. CONCLUSION: These first results suggest that the usage of amifostine offers new potential ways for re-irradiation of patients with recurrent or second malignancies in the head neck region.
Subject(s)
Amifostine/pharmacology , Cytoprotection , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Neoplasm Recurrence, Local/therapy , Neoplasms, Second Primary/therapy , Radiation-Protective Agents/pharmacology , Adult , Aged , Amifostine/administration & dosage , Anemia/etiology , Anemia/prevention & control , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Brachytherapy , Carboplatin/administration & dosage , Carboplatin/therapeutic use , Combined Modality Therapy , Deglutition Disorders/etiology , Deglutition Disorders/prevention & control , Female , Head and Neck Neoplasms/surgery , Humans , Leukopenia/etiology , Leukopenia/prevention & control , Male , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/radiotherapy , Neoplasms, Second Primary/drug therapy , Neoplasms, Second Primary/radiotherapy , Postoperative Care , Radiation-Protective Agents/administration & dosage , Radiotherapy/adverse effects , Radiotherapy Dosage , Stomatitis/etiology , Stomatitis/prevention & control , Thrombocytopenia/etiology , Thrombocytopenia/prevention & control , Time Factors , Xerostomia/etiology , Xerostomia/prevention & controlABSTRACT
A randomized study was conducted to evaluate the protective activity of amifostine (A) against the dose-limiting toxicities of radiochemotherapy (RCT). Patients with head and neck cancer received radiotherapy (2 Gy/day 5 days a week up to 60 Gy) with carboplatin 70 mg/m2 on days 1-5 and 21-25 inclusive. Patients either received RCT alone (n = 14) or RCT + A at a dose of 500 mg prior to treatment with carboplatin (n = 25). There was a significant reduction in the incidence of grade 3/4 mucositis (P < 0.0001), acute grade 2 xerostomia (P < 0.0001) and grade 3/4 thrombocytopenia (P = 0.012) in these patients who received A. The incidence of grade 2 late xerostomia at 12 months is 16.7% and the incidence of loss of taste is 0% in patients treated with A, as opposed to 54.5% and 63.6% in patients who received RCT alone. There were 18 (72%) complete responses (CR) and 6 (24%) partial responses (PR) in patients who received A, compared with 6 (43%) CR and 6 PR (43%) in patients treated with RCT alone. The disease-free survival at 12 months is 85.7% in the RCT + A arm and 78.6% in the RCT alone arm. The use of amifostine reduces the incidence and severity of acute and late toxicities associated with RCT whilst preserving antitumour activity.
