ABSTRACT
We have investigated the usefulness of combination therapy of HCFU with radiation by means of a multicenter trial from 1981 to 1984. One hundred fifty-three cases were registered and 120 of them were evaluable. The overall response rate was 72.5% with 55 complete responses and 32 partial responses. Adverse effects were found in 34.8% of patients. This combination therapy of HCFU with radiation was therefore concluded to be useful for multidisciplinary treatment of head and neck cancer.
Subject(s)
Antineoplastic Agents/therapeutic use , Fluorouracil/analogs & derivatives , Head and Neck Neoplasms/therapy , Antineoplastic Agents/administration & dosage , Combined Modality Therapy , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Fluorouracil/therapeutic use , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Humans , Male , Radiotherapy DosageABSTRACT
HCFU for oral use has a higher therapeutic ratio and a broader antitumor spectrum in murine tumors than other fluorinated pyrimidines. In the present study, HCFU was administered orally to 53 evaluable patients at a standard daily dose of 600 mg. The overall response rate was 22.6% with 6 complete responses and 6 partial responses. Adverse effects such as pollakisuria, anorexia, hot sensation, general fatigue, CNS and so on, were observed in 36.6% of patients. We conclude that HCFU therapy is expected to be useful for multidisciplinary treatment because of the above findings which suggest this drug is an effective chemotherapeutic agent for the treatment of head and neck cancer.
Subject(s)
Antineoplastic Agents/therapeutic use , Fluorouracil/analogs & derivatives , Head and Neck Neoplasms/drug therapy , Administration, Oral , Antineoplastic Agents/administration & dosage , Drug Administration Schedule , Drug Evaluation , Fluorouracil/administration & dosage , Fluorouracil/therapeutic use , HumansABSTRACT
A clinical trial of high dose methotrexate (MTX)-CF rescue was conducted in 17 institutions. Forty-seven patients with head and neck cancer entered this trial, of which 29 were evaluable. In this series, the patients were divided into 2 groups (Arm I, Arm II), according to physician's selection. MTX was administered 700 mg/m2 (1000 mg/body) in Arm I and 1750 mg/m2 (2500 mg/body) in Arm II by i.v. drip over 6 hours. Twenty-four hours after initiation of MTX infusion, CF rescue was started. There was no complete response in 29 patients. Four patients showed partial response with an overall response rate of 13.8%. There were 4 partial responders out of 21 patients in Arm I, with a response rate of 19%, whereas there was no partial responders out of 8 patients in Arm II. These results showed no apparent dose response. MTX concentrations in plasma were determined at 6, 24, 48 and 72 hours after initiation of MTX infusion. The assay results revealed a safe range in Arm I, but exceeded in 3 cases of Arm II. GI disturbances were seen at the rate of 78%. Bone marrow suppression was remarkable and hepatic toxicity was observed as the rate of 41%. No renal toxicity was observed. The results of high dose MTX-CF rescue therapy were not better than those of moderate dose therapy, so that we concluded that MTX should be used as one agent at low or moderate dose in combination chemotherapy as far as Japanese patients with head and neck cancer are concerned.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Carcinoma, Squamous Cell/drug therapy , Head and Neck Neoplasms/drug therapy , Leucovorin/administration & dosage , Methotrexate/administration & dosage , Adult , Aged , Carcinoma, Squamous Cell/blood , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Head and Neck Neoplasms/blood , Humans , Male , Methotrexate/blood , Middle AgedABSTRACT
The crude and determinate 5 year survivals out of 264 cases were 28.4% and 34.6% respectively. There were 136 cases in which the recurrence located at the primary site only. Whereas surgery performed on 81 cases resulted in the determinal survival rate of 58.0%, radiation therapy for 42 cases could attained only 19.5% survival. Cryotherapy were performed on 4 localized recurrent lesions and all but one which died of other cause are living well for more than 5 years. In 58 cases, the recurrence appeared only in neck nodes. Determinate 5 year survival rate of 64.7% could be obtained out of 40 cases treated by radical neck dissection. Only 7.1% of cases treated otherwise survived more than 5 years. Results of treatment were poor in the 39 cases in which both the primary and neck nodes were involved by recurrences. Only one case survived more than 5 years which had undergone composite operation. Introduction of composite operation simultaneously combined with reconstruction extended the indication of radical therapy. Seventy-eight cases which would have been the candidate for palliative treatment underwent this type of surgery, and 41.0% of them survived more than 5 years. It is noteworthy that radical treatment is still reserved for many recurrent cases of head and neck carcinoma. And salvage operation, if indicated, promises the best results among various methods of treatment.
Subject(s)
Head and Neck Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Brachytherapy , Combined Modality Therapy , Cryosurgery , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/radiotherapy , Humans , Lymphatic Metastasis , Neoplasm Recurrence, Local/mortality , PrognosisABSTRACT
The proposal of the JJC, established in 1977 in an effort to establish a TNM classification of maxillary sinus carcinoma, proved superior to the American Joint Committee for Cancer Staging and End Results Recording (AJC) proposal in terms of reproducibility, well-balanced distribution of cases of T, and prognostication using TNM as the indices, after a nationwide analysis of 474 N0M0 Patients who were among the 541 patients first treated between 1970 and 1973 in 11 leading Japanese medical institutions. The number of patients, with their 5-year cumulative survival rates in parentheses, classified by T1, T2, T3, and T4 were as follows: AJC proposal - 0 (-), 21 (68%), 283 (44%), and 170 (31%); JJC proposal - 6 (83%), 148 (51%), 237 (40%), and 83 (22%). The 283 cases for T3 under the AJC classification are to be redistributed over three JJC T units of T2, T3, and T4, with the respective numbers of cases and 5-year cumulative survival rates of 133 (50%), 128 (41%), and 22 (26%). In a similar manner, the 170 T4 cases under the AJC classification are reclassified into 109 (37%) for T3 and 61 (20%) for T4 under the JJC proposal. The JJC proposal enables closer prognostication than the AJC.
Subject(s)
Maxillary Sinus , Paranasal Sinus Neoplasms/classification , Humans , Maxillary Sinus/pathology , Neoplasm Staging , Paranasal Sinus Neoplasms/pathologyABSTRACT
A clinical trial of moderate dose methotrexate (MTX)-CF rescue was conducted in 12 institutions. Thirty-seven patients with head and neck carcinoma entered this trial, of which 32 were evaluable. MTX was administered 350 mg/m2 (500 mg/body) by i.v. drip over 6 hours. Three hours after completion of MTX infusion, CF rescue was started. There was no complete response in 32 patients. Nine patients showed partial response with the response rate of 28%. The response rates were 21% for the group of patients treated previously, and 75% for the group untreated previously. MTX concentration in plasma was determined at 6, 24, 48 and 72 hours after the initiation of MTX infusion, and the assay results revealed a safe range. GI disturbances were seen at the rates of 11 to 38%. Bone marrow suppression was mild and no renal toxicity was observed. We concluded that the moderate dose MTX-CF rescue therapy was useful for head and neck carcinoma. As a next step, we are planning to conduct a clinical trial of high-dose MTX.
