A new concurrent chemotherapy with vinorelbine and mitomycin C in combination with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck.

OBJECTIVE: The purpose of this pilot study was to evaluate the feasibility and toxicity of concurrent chemotherapy with vinorelbine and mitomycin C in combination with accelerated radiotherapy (RT) in patients with locally advanced cancer of the head and neck. PATIENTS AND METHODS: Between January 2003 and March 2004, 15 patients with T4/N2-3 squamous cell carcinoma (12/15) and with N3 cervical lymph node metastases of carcinoma of unknown primary (3/15) were treated with chemotherapy and simultaneous accelerated RT. RESULTS: 11 patients completed therapy without interruption or dose reduction. Grade 3-4 acute mucosal toxicity was observed in 9/15 patients, grade 4 hematologic toxicity in 6/15 patients. At a median follow-up of 7.5 months, 2 patients have died of intercurrent disease, 2 patients have experienced local relapse; 5 patients are alive with no evidence of disease at the primary tumor site. DISCUSSION: The described regimen is highly effective, but led to remarkable side effects.

Depressive symptoms during and after radiotherapy for head and neck cancer.

BACKGROUND: Patients with head and neck cancer are extraordinarily susceptible to depressive traits. Thus, a general screening of these patients at their first admission to the ital is desirable. METHODS: From 1997-2001, 133 patients with head and neck tumors filled in the Self-Rating-Depression-Scale (SDS) at the beginning and end of radiotherapy (ti1/ti2), 6 weeks, and 6 months after radiotherapy (ti3/ti4). RESULTS.: The SDS index increased significantly from 46.44 (ti1) to 48.91(ti2) (p =.025) and then remained stable. The subdomain "somatic-eating-related symptoms" at ti1 was significantly lower than ti2 (p <.001). In contrast to inpatients, outpatients and those with conventional instead of hyperfractionated-accelerated radiotherapy were less impaired by eating-related symptoms. Patients with higher education showed a lower SDS index and cognitive scale. Marital status, tumor stage, histologic grading, and substance abuse had no influence. CONCLUSIONS: Patients with a higher risk of depression should receive long-term monitoring during and after the end of radiotherapy, and prompt intervention strategies should be applied.

Psychosocial stress in cancer patients during and after radiotherapy.

BACKGROUND AND PURPOSE: The aim of this study was to investigate stress in tumor patients by means of a cancer-specific questionnaire in the course of radiotherapy. MATERIAL AND METHODS: Disease-specific aspects of psychosocial stress (Herschbach's Questionnaire on Stress in Cancer Patients, QSC) were self-assessed by patients with different tumor types before radiotherapy (ti1), after radiotherapy (ti2), and 6 weeks after the end of radiotherapy (ti3). We investigated 265 of 446 patients (157 male, 108 female; median age 58.6 years) with complete data of ti1-ti3. RESULTS: In the course of investigation, the most prominent stress scale of the patients proved to be physical efficiency, without significant changes during treatment and after therapy. Significant increases in stress were observed for anxiety, pain, and information at ti3 (p < 0.001, p = 0.001, p = 0.035). Women showed significantly higher stress from ti1 to ti3, younger patients displayed a decrease in anxiety, whereas elderly patients demonstrated an increase (p = 0.016). Breast cancer patients had the highest stress levels. The probability of correctly predicting increase in stress (sensitivity) was 78% and the specificity 67%. The relevant predictor variables were tumor stage, addiction to alcohol or nicotine, metabolic disorder, marital status, and age. CONCLUSION: Patients who experienced stress at the beginning of radiotherapy also had the same or increased levels of stress during and shortly after treatment and needed permanent psychosocial support to improve quality of life. The identification of patients with high stress levels at the beginning of therapy could be helpful.

Only sociodemographic variables predict quality of life after radiography in patients with head-and-neck cancer.

PURPOSE: Psychosocial factors influence patient compliance and have an effect on survival. Identifying patients at risk of decreased quality of life (QOL) with no extra expenditure in terms of hospital staff time or resources is mandatory to plan psychosocial support. METHODS AND MATERIALS: Between 1997 and 2000, 242 patients with head-and-neck cancer (30% pharyngeal, 29% oropharyngeal, and 13% laryngeal cancer) were screened. Of these, 28.5% refused to participate and 19.0% were excluded (Karnofsky performance score <50, language and cognitive deficits, death, or noncompliance). A total of 124 patients were assessed with the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at ti1 (beginning of radiotherapy [RT]). Eighty-three patients from this group were examined, with complete data from ti1 to ti3 (6 weeks after RT). RESULTS: The QOL did not change during RT. In logistic regression analysis, medical information, in contrast to sociodemographic variables, turned out to have no influence on the ability to predict low QOL (sensitivity 80% vs. 32%). Four sociodemographic variables were entered in the regression model (children, currently employment, ethanol abuse, level of secondary education) and accounted for 26% of variance in QOL at ti3. CONCLUSION: By routinely obtaining clinical information from the patient's history, patients at risk of low QOL after RT can be identified and could benefit from early psychosocial support.