High dose methotrexate as a preoperative adjuvant in the treatment of epidermoid carcinoma of the head and neck. A feasibility study and clinical trial

Thirty patients with operable epidermoid carcinoma of the head and neck were treated with intravenous high dose methotrexate and leucovorin rescue prior to resection. Their clinical courses were compared with those of thirty randomly selected patients matched for tumors site and clinical stage who were treated by surgery alone. No medical or surgical complications associated with methotrexate were encountered. An objective decrease in tumor size (primary lesion or nodal metastases) was noted prior to resection in twenty-three patients (77 per cent). The number of recurrences in the two groups was similar. However, these was a significantly greater disease-free interval in the methotrexate-treated patients (p less than 0.05). No significant differences in survival have been noted to date between the two groups. In view of the absence of complications, the regressions in tumor size, and the increase in postoperative disease-free interval in this trial, evaluation as preoperative adjuvants of higher doses of methotrexate and of other chemotherapeutic agents in combination with methotrexate appears warranted.

Preoperative irradiation for squamous cell carcinoma of the head and neck. Does it improve five year survival or control figures?

1. A well defined group of patients have been studied. 2. Composite operation resulted in a 56 per cent five year disease-free survival rate. 3. Treatment of recurrent disease with irradiation increased the five year survival to 61 per cent. 4. Preoperative irradiation for squamous cell carcinoma of the intraoral cavity, stage III, is unwarranted unless this treatment plan can produce five year end results better than 61 per cent.

Methotrexate and radiation therapy in the treatment of advanced head and neck tumors

Ninety-six patients with advanced squamous cell carcinoma of the head and neck were randomized to treatment with intravenous methotrexate followed by radical irradiation or radiotherapy alone. No significant differences were demonstrated in local disease control or actuarial survival rates at three and five years. Some patients with local treatment failure were surgically salvaged.

Delayed hypersensitivity in patients treated by curative radiotherapy. Its relation to tumor response and short-term survival

Delayed hypersensitivity, as determined by skin reactivity to 2-4 dinitrochlorobenzene (DNCB), was tested in 112 patients prior to their undergoing curative radiotherapy. Of the strong DNCB reactors, 84% had an excellent radiation tumor response, while only 48% of the negative reactors had an equivalent response. Almost twice as many strong DNCB reactors were alive and free of disease (NED) at 6 months (70% vs. 38% for nonreactors). Similarly, the positive DNCB reactors had a median survival of 18 months, compared to 10 months for the nonreactors.

First results of a randomized clinical trial of fast neutrons compared with X or gamma rays in treatment of advanced tumours of the head and neck. Report to the Medical Research Council

Results of the first randomized clinical trial to compare the effects of fast neutrons and those of x or gamma rays (photons) in treating patients with advanced tumours of the head and neck are reported. In 37 out of 52 patients treated with neutrons and 16 out of 50 treated with photons the local tumour completely regressed; the tumour later recurred in nine of the 16 photon patients but in none of the 37 neutron patients. The advantages to the neutron-treated patients were seen in tumours of well and poorly differentiated histology and in each site. Complications after treatment did not differ significantly between the groups. Despite these substantial differences in local control of the tumour there were no significant differences in mortality between the series. A detailed study of the effective doses and the response of tumours and normal tissue in each series indicated that the improved results from neutron therapy were due to differences in the biological quality of the beam and not to the rather higher average effective dose in the neutron series. To assess the long-term effects of neutron treatment patients in earlier stages of disease and with smaller tumours should be included in the next phase of the trial.

Evaluation of University of Florida split-course technique for various head and neck squamous cell carcinomas

A retrospective evaluation was made of 260 patients with squamous carcinoma of various head and neck sites in order to determine the relative value of continuous vs. split-course irradiation techniques. There was no obvious difference in local control or survival in early-stage cases. The continuous technique resulted in a better local control and survival rate in moderately advanced and advanced stages. Complications were less severe in the split-course cases.

Synovial sarcoma of the neck: a followup study of 24 cases

This article reviews the clinicopathologic features and the biological behavior of 24 cases of synovial sarcoma that took origin from the cervical prevertebral connective tissue space and manifested as a retropharyngeal tumor or as a palpable mass in the anterior or posterior cervical triangle. The age of the 24 patients ranged from 10 to 51 years, with a median of 19 years. Ten patients were women and 14 men. Hoarseness or difficulty in breathing or swallowing were the first symptoms in eight patients. The tumors were solitary and ranged from 2 to 10 cm in greatest dimension. Microscopically, all of the cases showed the characteristic biphasic cellular pattern of a synovial sarcoma, with epithelioid and fibrosarcoma-like areas in varying proportions. Synovioblastic origin of the neoplasm was confirmed by the results of histochemical staining procedures and, in 1 case, by the examination with the electron microscope. Of the 21 cases followup information, 12 had died (10 with pulmonary metastasis) and 9 were alive and free of symptoms. Prompt and complete surgical removal is required to prevent complications from recurrent tumor growth or metastasis.

The management of cervical lymph nodes in head and neck cencer

It is suggested that the last major improvement in the surgical treatment of head and neck cancer was Crile's description of radical neck dissection in 1906, and that modifications of this procedure, including extended surgery, have made little or no difference to survival rates. It is hoped that some means may soon be found of identifying those patients with head and neck cancer who do badly--the majority. As a start, it is proposed that patients with an antral carcinoma and a gland in the neck, and patients with hypopharyngeal carcinoma and bilateral neck glands should not be treated by surgery. A retrospective analysis is made of matched pairs drawn from a personal series, one patient in each pair having had a prophylactic neck dissection, and one having been submitted to a policy of 'wait and see'. The survival rate for patients undergoing prophylactic neck dissection was worse than that of the wait and see group; this difference was statistically significant.

Recurrent head and neck cancer: the results of treatment

A study of 144 patients with cancer of the head and neck showed that 67 (46 per cent) developed recurrent cancer. Radical second treatment, almost exclusively by surgery, secured an 11 out of 67 or 16 per cent crude 5-year survival rate for recurrent head and neck cancer. Further analysis showed that the prospects of successful second treatment were negligible or nil with certain identifiable tumours or tumour sites. When these identifiable cases are excluded the survival rate for head and neck cancer became 11 out of 45 or 24 per cent. Age and general condition rendered some patients unfit for radical surgery. In this series 30 patients were treated by radical surgery with a patients cured: patients surgically treated ratio of 11 out of 30 or 36 per cent.

Fibrosarcoma of the head and neck: a clinical analysis of forty cases

This paper is a clinical analysis of 40 patients with fibrosarcoma of the head and neck treated at the Washington University Medical School, St. Louis, Missouri. Follow-up ranged from 6 to 25 years in 31 patients. Treatment consisted of widefield surgical excision, surgery and irradiation, narrowfield surgery, and irradiation alone. Histological classification of the tumors correlates well with the prognosis. In the well differentiated tumor group 12 out of 16 patients treated for a cure were free of tumor. In the poorly differentiated group only one out of five treated for a cure was free of tumor. Widefield surgical excision is the treatment of choice. Prophylactic radical neck dissection is not indicated. Narrowfield surgical excision resulted in a high recurrence rate although the salvage rate was excellent with subsequent widefield resection. Irradiation therapy produced good palliative results in those patients treated by irradiation alone and has a definite role in the management of this disease.

Massive infiltrating cystic hygroma of the neck in infancy

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