Purpose. A single-institution prospective pilot study was conducted to the assess correlation between salivary amylase and xerostomia in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT). Methods and materials. Serum saliva amylase, clinician-reported xerostomia (using Common Terminology Criteria for Adverse Events), and patient-reported xerostomia (using 8-item self-reported xerostomia-specific questionnaire) were prospectively collected at baseline, during treatment and thereafter. Correlations between variables were assessed by correlation matrices. Results. Twelve patients with locally advanced HNSCC formed the cohort. Eighty-three percent were male, 75% were smokers, 100% had clinical positive lymph nodes at diagnosis, and 42% received induction chemotherapy. All patients received IMRT with concurrent cisplatin-based chemotherapy. No grade ≥4 xerostomia was observed. Severe (G3) acute and late xerostomia occurred in five cases (41.7%) and two cases (16.7%), respectively. Patient-reported xerostomia scores were highly correlated with the clinician-reported scores (ρ = 0.73). A significant correlation was recorded between the concentration of amylase and the acute (ρ = −0.70) and late (ρ = −0.80) xerostomia. Conclusion. Preliminary results are encouraging. Prospective clinical trials are needed to define the value of salivary amylase in the management of HNSCC tumors.

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Aim: To assess feasibility, complications and efficacy of induction chemotherapy followed by standard chemoradiotherapy in patients with bulky anal canal cancer. Patients and Methods: Patients with squamous cell carcinoma of the anal canal, staged bulky tumor with or without nodal involvement were prospectively enrolled. Before standard chemoradiotherapy, patients received induction chemotherapy with 3 cycles of 75 mg/m 2 cisplatin and 750 mg/m 2 5-fluorouracil. Patients were followed-up routinely until recurrence or death. Results: Seven patients with bulky anal canal cancer were evaluable for this pilot phase of the study. All patients had human papillomavirusnegative disease. Five completed the scheduled induction chemotherapy and all patients completed the programmed concomitant chemoradiotherapy. None had severe hematological toxicity. The majority of patients (6/7) had tumor downsizing after induction treatment. Six months after chemoradiotherapy, complete response was documented in three patients and salvage surgery was performed in two cases. With a median follow-up of 38 months (range=28-48 months), two patients are disease-free survivors. Conclusion: Induction chemotherapy has the potential to become a standard approach in patients with bulky human papillomavirus-negative anal canal cancer.The optimal management of non-metastatic anal canal carcinoma is definitive chemoradiotherapy (1). Radical surgery consisting of abdomino-perineal resection (APR) is usually reserved for those with residual/recurrent local disease (1). Bulky anal canal tumor has a worse prognosis (<40% at 5 years) and its treatment should probably be more aggressive (2). Based on empirical data and on the efficacy demonstrated in patients with rectal cancer (3), induction chemotherapy may play a crucial role in cases of bulky primary anal canal cancer, favoring tumor down-sizing and early eradication of micrometastases, without affecting compliance with subsequent standard chemoradiotherapy.The aim of the present single-center prospective study was to evaluate the feasibility and the clinical outcomes of induction chemotherapy followed by standard chemoradiotherapy (CRT) in patients with bulky anal canal carcinoma.

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