Combined radiochemotherapy is the most common method aimed at improving the rate of clinical response in advanced head and neck cancer. Complete clinical remission may correspond to a significant percentage in organ and/or function preservation. In 1992 a protocol of concomitant radiochemotherapy with continuous infusion of carboplatin for 14 consecutive days at the daily dose of 30 mg/m2 and concomitant radiotherapy with conventional fractionation (1.8 Gy to a total 65-70Gy) was started. Over a 3-year period, 56 patients with advanced head and neck cancer, were treated. In view of organ preservation, 26 patients of this series, though with considerable extent of the disease at diagnosis, were considered candidates for radical surgery: oral cavity 9 patients; oropharynx 9 patients; larynx/hypopharynx 8 patients. A single patient was stage I (hypopharynx); most patients were stage III (7) and IV (17 = 65%); T4 20%, N3 23%. 17/20 patients (70%) showed complete clinical response, 6 partial clinical response with a single non responder (overall response 95%). A patient underwent total glossectomy followed by local recurrence and another patient underwent pharyngolaryngectomy also followed by recurrence. After a mean follow-up from 22 to 60 months, 9 patients were still free of disease (37.5%). Median duration of complete response was 25.6 months. Overall median survival was 26.7 months: 38 months in responders. 2-year survival of patients with complete response was 59%. As for organ preservation, at present 6 over 18 patients (33%) with tumor of the oral cavity or oropharynx and 3 patients with tumors of larynx/hypopharynx have preserved organ and function. As for complete responders, 54.5% of those with tumors of oral cavity or oropharynx and 50% of those with tumors of larynx/hypopharynx, have preserved anatomy and function after at least 2-year follow-up. To-date, in follow-up controls relevant late toxicity has not been observed, showing that to the positive anatomical result corresponds the functional preservation of single structures.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Organ preservation with radiochemotherapy in locally advanced bladder cancer.

Bladder cancer is frequent in Western countries and predominantly affects males (ratio: 3:1). In 15-25% of cases there is muscular wall invasion. Treatment of > T1 tumors is radical cystectomy with or without preoperative radiotherapy. In T2 there is 60% survival at 5 years, 40% in T3. Exclusive radiotherapy used to prevent radical cystectomy has lower survival rates in T2 (30-40% at 5 years) as well as in T3 (20% at 5 years). Recently, concomitant radiotherapy and chemotherapy has been introduced again to prevent demolitive surgery. Results are similar or slightly superior than those of surgery alone. In our experience with radiotherapy 180 cGy daily for a total dose of 64 Gy in combination with fluorouracil in locally advanced tumors 40% bladder preservation was achieved.

Aged↗

PubMedDate not supplied

Chemoradiotherapy with carboplatin in continuous infusion in the locoregional control of advanced head and neck cancer.

Because of the difficulty to achieve and maintain locoregional control in head and neck cancer, many clinical trials were focused on the addition of chemotherapy to locoregional treatments in advanced head and neck cancer patients. In particular, concomitant chemoradiotherapy resulted in high response rate and improved local control, sometimes with increased toxicity. In the effort to improve local control a phase II study on chemoradiotherapy with carboplatin in prolonged continuous infusion for 14 days (420 mg/m2 total dose) during standard radiotherapy, was performed. 45 patients were evaluable for response: CR 62.5% (global response 96%). After a mean follow-up of 48 months 9/28 patients with CR were still alive with no evidence of disease; two additional patients were alive but with locoregional disease. As for deceased patients, one died from non-tumor related causes, 13 from locoregional disease and 2 for metastatic disease. If the entire population of Crs is analyzed, it is observed that 13 patients (46.5% of CRs and 29% of the entire series) maintained a durable locoregional control. In most patients recurrence was detectable both in the primary tumor and in the neck.

Antineoplastic Agents↗