Triple therapy for advanced cancer of the head and neck

In vitro sensitivity and resistance of cultured human squamous carcinoma cells to cis-platinum and methotrexate

To determine whether resistance to chemotherapy in advanced head and neck squamous cell carcinoma stems from biochemical mechanisms and to assess the potential usefulness of new anticarcinogens, an in vitro test would be highly desirable. In the past 4 years our laboratory has developed methodology to establish squamous carcinoma cell lines in tissue culture from patients with squamous cancer of the head and neck. We used some of these lines to compare the in vitro effects of methotrexate on squamous carcinoma, fibrosarcoma, and melanoma cells. Three of the squamous carcinoma lines were tested for sensitivity to both methotrexate and cis-platinum; all but one squamous carcinoma cell line exposed to methotrexate showed growth inhibition at the physiologically attainable concentration of 10(-7) M. In contrast, a tenfold higher concentration was required to produce similar effects in the melanoma, while no concentration inhibited fibrosarcoma growth. Cis-platinum showed consistent squamous carcinoma cytotoxicity in 10(-5) M and 10(-6) M concentrations. This approach should be useful for determining the relative sensitivity and resistance of head and neck cancers to chemotherapeutic agents in vitro.

High-dose radiation therapy in carcinoma of the pyriform sinus

In a retrospective analysis of 61 patients with carcinoma of the pyriform sinus, treated primarily with high doses of radiation therapy with surgery reserved for persistent or recurrent tumor, survival rates of 56.5% and 12.4% were found in Stages III and IV, respectively. The two patients with Stage II disease were cured. There were no Stage I patients. The local control of T4 lesions and N2-3 lesions, as well as the survival of patients with Stage IV disease, is poor with radiation alone. This points out the necessity of combining irradiation with surgery and/or chemotherapy for Stage IV disease. The results in early stages with radiation alone are acceptable.

Role of radiation therapy in carcinoma of the hypopharynx

In a series of 199 patients with hypopharyngeal carcinoma treated with irradiation, the primary tumor was controlled in 63 per cent, 54 per cent, 44 per cent and 14 per cent of T1-T4 lesions, respectively. The five-year actuarial survival for stages I, II, III and IV patients was 60 per cent, 66 per cent, 49 per cent and 18 per cent. It was significantly better in patients with tumors located at the upper hypopharynx (p = 0.024). Early lesions yielded satisfactory results with irradiation alone. Advanced tumors had poor prognosis and other treatment modalities along with irradiation should be tried.

Prognostic factors in oral squamous carcinoma and their relation to clinical staging

One hundred and three patients with an oral squamous carcinoma were studied in an attempt to determine the clinical factors which affect survival. The 5 yr actuarial survival of the whole group of patients was 55%. Although survival depended on clinical staging, in those patients with no palpable nodes on presentation the tumour size did not affect survival. The most significant factor determining survival was the presence of palpable lymph nodes on presentation. Palpable nodes were more likely in patients with large tumours than those with small tumours. On the basis of these findings a modification of the TNM classification is suggested giving more weight to the presence of cervical nodes than in the present staging system.