Chemotherapy for advanced carcinoma of the head and neck. A clinical update

Comparisons of histological features among primary oral squamous cell carcinomas before and after adjuvant chemotherapy and their lymph node metastatic cancer lesions after adjuvant chemotherapy

Background/purpose

Adjuvant chemotherapy has been used to control the primary oral squamous cell carcinoma (OSCC) size prior to surgical excision of the cancer. This study aimed to explore the histological changes of primary OSCCs and their cervical lymph node metastatic cancer lesions after chemotherapy.

Materials and methods

Thirty-three OSCC patients with eleven having cervical lymph node metastases received adjuvant chemotherapy before surgical excision of their cancer lesions. Hematoxylin and eosin-stained tissue sections of incisional biopsy, surgical excision, and cervical lymph node metastatic cancer lesion specimens were compared microscopically to observe the histological changes in the cancer tissues after chemotherapy.

Results

Common histological features could be found in the primary OSCCs and their cervical lymph node metastatic cancer lesions after chemotherapy. These included direct killing of cancer cells by chemotherapeutic agents, resulting in cancer cell necrosis and degeneration in the early phase, and squamous and keratinizing metaplasia of drug-induced cancer cells, leading to individual cell keratinization and keratin pearl formation in the later phase. There were also small nests of drug-resistant proliferating cancer cells in the inflamed fibrous connective tissue stroma. The most characteristic histological feature in the metastatic lymph nodes after chemotherapy was the keratinizing metaplasia of the metastatic cancer cells, resulting in the formation of epidermoid cyst-like lesions.

Conclusion

Although the cancer reduces its size after chemotherapy, residual cancer cells are consistently present in the primary OSCC lesions after chemotherapy. Therefore, wide surgical resection of the cancer is still needed to ensure the complete removal of all cancer tissues.

VBM Chemotherapy before Curietherapy in the Treatment of T2 Oral Carcinomas

According to previous personal experience with conventional 226-Ra sources, in T2 oral carcinomas treated with curietherapy alone the incidence of local failures was 23%. Moreover, 50% of the local relapses were marginal with respect to the treated volume. From May 1980 to November 1981, 29 T2 oral carcinomas suitable for correct curietherapy received 3 weekly courses of VBM chemotherapy: i.e., vincristine, 1 mg i.v.; bleomycin, 15 mg i.m. after 6 and 24 h; and methotrexate, 30 mg p.o. after 48 h. A full dose curietherapy was performed 2 weeks after the completion of VBM. Twenty-seven patients have had a minimum follow-up of 12 months. The overall treatment was well tolerated and immediate results were encouraging. However, the local failure rate does not seem to have decreased by the combined treatment in comparison with curietherapy alone in historical series.

Synergistic antitumor activity of cisplatin and UFT in nude mice bearing transplantable nasopharyngeal hybridoma

Combination therapy with cisplatin (CDDP) and UFT, a drug prepared with 1-(tetrahydro-2-furanyl)-5-fluorouracil and uracil at a mixing molar ratio of 1:4, was examined in nude mice bearing transplantable human nasopharyngeal hybrid cell (A2L/AH). The tumor growth of A2L/AH was inhibited in the group administered UFT 20 mg/kg, but was not in 10 mg/kg group in comparison with the control group. An inhibition rate (IR) of the tumor growth at 20 mg/kg and 10 mg/kg doses was 80.2 and 21.3%, respectively. The group received CDDP (5 mg/kg, q7d x 3, 2 mg/kg, q7d x 3, and 1 mg/kg, qd x 6) by intraperitoneal injection, resulted in 75.2, 37.4, and 23.1% inhibitions, respectively. While, the response rate in the group treated with CDDP (1 mg/kg, qd x 6) and UFT (10 mg/kg) showed a synergistic effects (IR, 66.3%) which was higher than in the group administered CDDP (2 mg/kg, q7d x 3) and UFT (10 mg/kg) (IR, 58.3%).

Cisplatin and 5-fluorouracil infusion in patients with recurrent and disseminated epidermoid cancer of the head and neck

The combination of cisplatin and 96-hour infusion of 5-fluorouracil (5-FU) was evaluated in 30 patients with recurrent (local and regional) and disseminated histologically proven epidermoid cancer of the head and neck who failed surgery and radiotherapy. Cisplatin 100 mg/M2 intravenous (IV) bolus was given on day 1 with hydration and mannitol diuresis; 5-FU 1000 mg/M2 per day for 96-hour infusion was started immediately after cisplatin on day 1. All patients had measurable lesions. Eight (27%) patients achieved complete response (CR), and 13 (43%) had partial response (PR). Overall response rate was 70% (8 of 30 CR and 13 of 30 PR). Response rate in patients with recurrent local and regional disease was 89% (17/19) with median survival of 32 weeks, while response in patients with disseminated disease was 36% (4/11) with median survival of 24 weeks. Patients with good performance status (PS) (greater than or equal to 70%) had a response rate of 79% (19/24), while those with poor PS (less than 70%) had a response rate of 33% (2/6). Seven patients with recurrent disease who had a response to this chemotherapy went to further salvage surgical procedures. It is concluded that the combination of cisplatin and 5-FU is very effective and well tolerated in these patients, and leads to further salvage in some patients with improved longevity and quality of life.

Heterotransplantation of human head and neck tumours into nude mice

Multimodality therapy of advanced malignant tumours of the head and neck includes surgery, radiotherapy and chemotherapy. However, the cure rate for these tumours is low and guidelines for the selection and timing of therapy are needed. For such guidelines, tumour cell kinetic parameter studies, e.g. cell proliferation, may be a suitable approach. In the present study an in vivo system for tumour cell kinetic studies, the nude mice system, has been evaluated for malignant human head and neck tumours. The overall 'take' rate for heterotransplanted human tumour grafts was 35%. The take rate was not influenced by the sterility state of the specimen. An advanced tumour stage showed a tendency to a higher take rate than less advanced tumour stages. In the tumour cell kinetic study the rate of DNA synthesis, measured by incorporation of radioactively labelled thymidine ( [3H]TdR) into DNA, was analysed in human malignant head and neck tumours and in serially heterotransplanted tumours. The rate of DNA synthesis was found to increase during the first serial passages though the histopathological picture remained unchanged. The increased rate of DNA synthesis may be explained by the recruitment of Go cells or by stem cell selection. These findings are discussed and may provide a basis for therapeutic guidelines.