Neoadjuvant chemotherapy consisting of cisplatin and continuous infusions of bleomycin and 5-fluorouracil for advanced head and neck cancer: the need for a new stratification for Stage IV (M0) disease
Article Abstract:
Patients with advanced cancer of the head or neck generally have a poor prognosis. Despite treatment with radiation, surgery, or both, 50 to 70 percent of these patients will experience cancer recurrence in the local area, and 30 percent will develop metastatic cancer at some distant site in the body. Only one in five is likely to be alive after five years. Recently, cancer researchers have turned their attention to the possibility of improving this record with neoadjuvant chemotherapy. In this technique, the cancer is first treated with chemotherapeutic drugs prior to the use of radiation or surgery as the so-called ''definitive'' treatment. Researchers have now evaluated a regimen of neoadjuvant chemotherapy that includes the drugs cisplatin, bleomycin, and 5-fluorouracil. The study found that both the response of the patients to treatment and the actual survival of the patients were strongly dependent upon the stage of the cancer. All patients had advanced cancers, but some were Stage III and some were Stage IV, according to international staging conventions. Forty percent of the Stage III patients (two of five) experienced complete responses to chemotherapy, and all five patients experienced at least a partial response. In contrast, only five of 49 Stage IV patients had complete responses and 55 percent had at least a partial response. The survival rate after definitive treatment with radiotherapy, surgery, or both was likewise different for the two stages. Four of five Stage III patients remain alive after an average of 38 months. In contrast, 7 of 49 Stage IV patients are alive. The researchers observed, however, that great variability was observed among the Stage IV patients. All seven Stage IV survivors were among 19 patients with a smaller degree of cancerous growth in their lymph nodes. In contrast, none of the remaining 30 patients with bulky growth in their lymph nodes survived. The authors suggest that careful attention must be paid to the details of head and neck cancer staging when evaluating the results of experimental treatment. They suggest that new definitions of Stage IV disease might be appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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A Phase II study of cisplatin and continuous infusion of vindesine in metastatic head and neck squamous cell cancer
Article Abstract:
Published reports of the chemotherapy response rates of patients with metastatic or recurrent squamous cell carcinoma of the head and neck vary widely, ranging from 3 to 73 percent. Unfortunately, patient survival rarely exceeds a year in any case. Examination of the published reports suggests that at least a part of the wide disparity among the remission rates achieved may be attributed to the heterogeneity of the patients included in the treatment groups. Since there is some indication that patients with metastatic tumors benefit more from chemotherapy than do patients with recurrences of the original tumor, a more homogeneous group of 33 patients with metastatic head and neck cancer was evaluated for their response to chemotherapy. The patients were treated with cisplatin and a continuous infusion of vindesine. A response rate of 52 percent was achieved; 16 percent were complete responses and 36 percent were partial responses. It is worth noting that of the three patients who had a local recurrence, in addition to metastatic disease, none responded to treatment. The median time to relapse was 6.4 months for the patients who achieved a complete response. The median survival time for the responding patients was seven months, and five months for the non-responding patients. Two patients who achieved complete responses are alive without evidence of disease at 7 and 19 months. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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Treatment of advanced squamous cell carcinoma of the skin with cisplatin, 5-fluorouracil, and bleomycin
Article Abstract:
Squamous cell carcinoma of the skin is relatively common, and the mortality from this cancer is low. Surgical treatment is followed by radiation to prevent recurrence. Normally, a cure rate of roughly 90 percent may be expected. However, larger cancers are more problematic, as they are generally less amenable to surgery and less susceptible to radiotherapy. One method of approaching large skin cancers is that of neoadjuvant chemotherapy. Neoadjuvant chemotherapy is adjuvant chemotherapy that is used before the primary therapy. In this case, chemotherapy can be used to reduce the size of a tumor, and make it more amenable to surgical removal, the primary therapy. The authors evaluated a combination of cisplatin, 5-fluorouracil, and bleomycin in the neoadjuvant chemotherapy of skin cancers larger than 5 centimeters in 14 patients. Eleven patients responded to treatment, four completely and seven partially. The toxic effects of the treatment included nausea and vomiting, transient skin changes, hematologic changes, and, in one case, pulmonary fibrosis. The authors suggest that this chemotherapy combination could play a useful role in preparing larger skin cancers for surgical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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