Japanese Journal of Clinical Oncology 30:253-258 (2000)
© 2000 Foundation for Promotion of Cancer Research
Survival Results of Neoadjuvant Chemotherapy for Advanced Squamous Cell Carcinoma of the Head and Neck
1Department of Otolaryngology, National Defense Medical College, Saitama, 2Department of Otolaryngology, Ohtsuka Metropolitan Hospital, Tokyo, 3Department of Otolaryngology, Yokohama Municipal Hospital, Yokohama, 4Department of Otolaryngology, Keiyu Hospital, Yokohama, 5Department of Otolaryngology, Tochigi National Hospital, Utsunomiya and 6Department of Otolaryngology, Nihon Medical College, Tokyo, Japan
Background: We carried out an open, randomized multi-center clinical trial for advanced head and neck cancer between April 1991 and December 1992. In this report, we update the results and analyze the 5-year survival results.
Methods: Thirty-two patients with previously untreated stage III and IV resectable squamous cell carcinoma of the oral cavity and pharynx were entered into the study. The PEM regimen consisted of cisplatin 60 mg/m2 2 h infusion on day 1, etoposide 40 mg/m2 1 h infusion on days 1, 2 and 3 and mitomycin-C 7 mg/m2 i.v. bolus on day 1.
Results: Among the 32 patients entered into this trial, eight were disqualified from the analysis. Of the remaining 24 patients, 13 were given neoadjuvant chemotherapy (NAC) and 11 underwent surgery alone. Among the 13 patients who received NAC, four achieved a complete response (31%) and three a partial response (23%), with an overall response rate of 54%. Myelosuppression was a major side effect. Thrombocytopenia and anemia were dose-limiting toxicities. Other adverse reactions, including mucositis, were all mild and transient. The overall 5-year survival after NAC and without NAC were 83 and 62%, respectively. The survival difference was not statistically significant (p = 0.33).
Conclusions: NAC does not appear to play a role in the treatment of cancer of the oral cavity and pharynx with our PEM regimen. However, the degree of toxicity was limited in our trial and therefore attempts to increase the dosage and/or revise the administration schedule for cancer of the pharynx and T1 to T3 tumor disease appear warranted.
+ For reprints and all correspondence: Naoyuki Kohno, Department of Otorhinolaryngology, National Defense Medical College, 3–2 Namiki, Tokorosawa, Saitama 359–8513, JapanPart of this work was presented at the 35th Annual Meeting of the Japan Society of Clinical Oncology, Kyoto, October 7–9, 1997. Abbreviations: NAC, neoadjuvant chemotherapy; CDDP, cisplatin; VP-16, etoposide; MMC, mitomycin-C; 5FU, 5-fluorouracil; CR, complete response; PR, partial response; MR, minor response; NC, no change; PD, progressive disease