Carcinoma of the oropharyngeal region is one of the most common malignant lesions seen in western India, comprising about 47% of all cases seen at the Gujarat Cancer and Research Institute. Of these, carcinoma of the tongue has the maximum incidence. In India the ratio between carcinoma of the anterior and posterior tongue is 33:66, the reverse of that published in Europe and America. The highest incidence of carcinoma of the anterior tongue appears in males 50 to 60 years of age; only 11 cases have been reported in patients under 20 years of age. From 1969 to 1974, 218 cases of carcinoma of the anterior tongue was seen at the M.P. Shah Hospital. This paper reports five cases of carcinoma of the anterior tongue found in patients under 20 years of age. Although the anterior tongue is a visible and approachable site, all five lesions were too advanced to cure. There did not seem to be any contributory factor to produce this malignant lesion at such a young age. The patients were all male, the youngest 11 years old. Two cases were treated with surgery; one also received postoperative radiotherapy. The remaining three cases were treated with palliative radiotherapy and chemotherapy. The pathology and the current view of management are discussed.

21186 Background: Recurrent, radiated and chemotherapy given patients are having many unmanageable symptoms and problems. This condition is worsened by malnutrion, infection, pain and immuno suppression. Modifying immune mechanism of the body is the last and best weapon to fight against such diseases. Role of immunotherapy in the treatment of malignant diseases is on experimental level. Dr George Thyphrontis & Michael Kousilers have produced good results in carcinoma of urinary bladder, melanoma & lung cancer with Immunotherapy. At GCRI, we have tried vaccine, prepared from mycobacterium-W in 100 cases of Head & Neck Cancer. Methods: As a prospective nonrandomized study, to see beneficiary effect on quality of life and symptom control, we have done a trial during Jan. 2004 to Dec.2005. Informed consent and ethical clearance was obtained. Study was made to find out any side effect or adverse reactions of the vaccine. After fulfilling the criteria of inclusion and exclusion the case was selected for study and 0.1 ml vaccine (CADI-05) was injected intradermally with all aseptic precautions. Four injections, weekly and later on four injections monthly were given. Patient was followed up for 6 months. Results: Total No. of cases -100. M / F - 89/11. age distribution - Maximum No. were in 5th decade -(34%) followed by 6th decade (21%)Site of primary - Commonest site was Buccal mucosa (29%) followed by tongue (17%). There was no major side effect. Only 5% Patients developed constitutional symptoms and infection at injection site. 27% patients had pain relief. Symptom control was seen in 15% patients. Improvement in quality of life was observed in 82% of patients. 4% of patients had no effect. The beneficiary effect lasted for three month in 27% patients and more than six months in 13% patients. The effect was more marked in dysphagia, ulcer and fistula. Effect was insignificant in strider, change in voice and metastatic nodes. Four patients are living with Immuvac in spite of disease symptom free for more than one year. Conclusions: Immunotherapy with Mycobacteium W can safely be used to improve quality of life and control of symptom in terminally ill Head & Neck cancer. No significant financial relationships to disclose.

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12512 Background: Poly TLR poly-antigenic vaccine containing Mycobacterium w (Mw) is found useful in the management of lung cancer and bladder cancer when used along with standard therapy1,2 but not in Head and Neck cancer3–4. This study was carried out to evaluate its efficacy as a single agent in advanced head & neck cancer. Methods: In a prospective study consecutive 75 symptomatic patients with advanced head & neck cancer (squamous cell) attending hospital for palliative care following failure of standard therapy were administered Mw once a week for 8 weeks. Results: Of 75 patients 43 were male & 32 females with 76% between the ages of 31 to 60). 18 had buccal mucosa tumor, 12 alveolar and 11 at base of the tongue. Partial response was seen in 27. It was associated with Pain relief (27/27), Healing of ulcer/fistula (4/5), improvement in dysphagia (7/15), improvement in voice(5/19). All 27 showed improvement in constitutional symptoms also. No systemic side effects were seen. Conclusions: Mw vaccine is useful in palliative care of head & neck cancer. Reference 1Sur PK, Dastidar AG. Role of mycobacterium w as adjuvant treatment of lung cancer. J Indian Med Assoc. 2003;101:118, 120. 2Chaudhuri P, Mukhopadhyay S. Bladder preserving approach for muscle invasive bladder cancer–role of mycobacterium w. J Indian Med Assoc. 2003;101:559–60 3M. C. Pant, R. Hadi, R. Prasad, D. Dalela, et al. Role of immuno-therapy as a adjuvant treatment in advance head & neck cancer, patient receiving chemo radiotherapy. Journal of Clinical Oncology 2005; 23, (16S Part 1): 190S 4S. K. Sarkar, C. Dasgupta. Role of Mycobacterium W as an adjuvant treatment of Head & Neck Cancer_A Randomised trial. Journal of Clinical Oncology 2005; 23, (16S Part 1): 521 s. No significant financial relationships to disclose.

17524 Background: In a developing country the affordability status of a patient is the main factor in deciding the type of treatment a patient will receive. Majority of patients [>95%] at our institute have received MCP 841 protocol for acute lymphoblastic lymphoma .We have reviewed the treatment results of patients who had received chemotherapy as per the BFM 90 protocol over last 3 years. Methods: 18 patients (15 males and 3 females) with ALL who had received BFM 90 protocol as therapy during the period between January 2003 to January 2006 were analysed. 15 were of the pediatric age group (2–13 years) and 3 were adult patients (31 & 42 years). Median follow up period was 1 year 9 months. 5 patients were considered as high risk, 4 medium risk and the rest as standard risk. All patients were ph chromosome negative. Results: All paediatric patients are in CR. One patient had CNS relapse but he responded well to reinduction and is in CR. Three patients developed grade 4 toxicity after high dose methotrexate. The rest tolerated it well, however, leucoverin rescue had to be given empirically as methotrxeate level measurement was not available at that time. Two patients turned HCV positive during the course of treatment and had altered liver enzymes due to which maintenance treatment was interrupted. There were three instances of catheter removal and one port had to be removed due to infection. Both the adult patients had bone marrow relapse during treatment [one during maintenance and the other during reinduction] and could not be salvaged. Conclusions: BFM 90 protocol is a viable alternative to MCP 841 in developing countries where high dose methotrexate is given with empirical leucoverin rescue. High rates of catheter infection is of concern. Better patient education and improved techniques will probably improve the situation. No significant financial relationships to disclose.