Why has so much chemotherapy done so little in head and neck cancer?

Taylor, Sophia

doi:10.1200/jco.1987.5.1.1

Cited by 36 publications

(4 citation statements)

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“…In order to reconcile the needs for early administration of both agents and for sequential delivery without a long interruption of one of the two modalities, we have developed an alternating treatment schedule in which CT and RT are interdigitated (Tubiana 1981, 1987 . This protocol has several advantages:…”

Section: Alternating Delivery Of Ct and Rtmentioning

confidence: 99%

“…In head and neck cancers, for example, despite a large number of controlled clinical trials, there is not yet a clear-cut demonstration of any increase in survival (DeVita et al . 1986, Tannock and Browman 1986, Taylor 1987 . These disappointing results are probably due to two factors : (1) the insufficient effectiveness of the available drugs on most solid tumours ; (2) the cumulative toxic effects of radiation and drugs on the normal tissues, which limits the dose of both modalities in combined treatments .…”

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confidence: 98%

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The Combination of Radiotherapy and Chemotherapy: A Review

Tubiana

1989

International Journal of Radiation Biology

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The association of radiotherapy (RT) and chemotherapy (CT) is clearly beneficial in tumours which are both chemosensitive and radiosensitive (Tubiana et al. 1987). However, contrary to the expectations, in most solid tumours this association did not lead to significant progress in long-term survival. In head and neck cancers, for example, despite a large number of controlled clinical trials, there is not yet a clear-cut demonstration of any increase in survival (DeVita et al. 1986, Tannock and Browman 1986, Taylor 1987, Tubiana et al. 1985). These disappointing results are probably due to two factors: (1) the insufficient effectiveness of the available drugs on most solid tumours; (2) the cumulative toxic effects of radiation and drugs on the normal tissues, which limits the dose of both modalities in combined treatments.

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Section: Alternating Delivery Of Ct and Rtmentioning

confidence: 99%

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confidence: 98%

The Combination of Radiotherapy and Chemotherapy: A Review

Tubiana

1989

International Journal of Radiation Biology

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“…Chemotherapy has been used extensively over the past two decades in the treatment of advanced squamous cell carcinomas of the head and neck, but few trials have suggested a survival benefit from its use [1][2][3][4]. Induction chemotherapy, or neoadjuvant chemotherapy, may be used to select a responding subset of patients for subsequent treatment with radiotherapy alone to avoid surgery in resectable stage III and IV disease [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Chemotherapy in Advanced Head and Neck Cancer

Colecchi¹,

Finkelstein

Fabian

1997

The Oncologist

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Purpose. Chemotherapy has been tested extensively in conjunction with standard therapy in the treatment of head and neck cancer, primarily in the form of neoadjuvant chemotherapy, but few trials have shown a survival benefit. Although a few studies have suggested that adjuvant chemotherapy given after standard treatment may improve survival, to date these trials have been troubled by various problems in design and dosing. The purpose of our trial was to determine the feasibility of giving moderately intensive chemotherapy exclusively after standard therapy, and to determine whether survival appeared to be improved as measured against historical data. Methods. We used adjuvant chemotherapy in two groups of patients with squamous cell carcinoma of the head and neck: group A consisted of 46 patients with newly diagnosed stage III and IV disease, and group B consisted of 46 patients with relapsed disease having been treated with salvage surgery. In all patients, the intended adjuvant chemotherapy consisted of two cycles of combination cisplatin, bleomycin, and infusional 5‐fluorouracil (5‐FU) given three weeks apart, followed by four cycles of bolus methotrexate, 5‐FU, and bleomycin given every two weeks. Results. In group A, the two‐year survival was 72%. In group B, the two‐year survival was 58%. Conclusion. Compared to the vast majority of similarly staged patients with head and neck cancer reported in the literature, the survival of our group seemed considerably better, suggesting that a definitive randomized study testing this schedule of adjuvant chemotherapy is warranted.

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“…4 Responses, when they occur, are usually short-lived, and the toxicity of treatment in this fragile population is substantial. 5 Attempts to modulate 5-FU have led to improved response rates in colorectal carcinoma. NPhosphonacetyl-L-aspartate (PALA) has been shown to inhibit pyrimidine biosynthesis and to increase incorporation of 5-FU metabolites into ribonucleic acid (RNA).…”

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confidence: 99%