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Current Role of Chemotherapy in Head and Neck Cancer

  • Practical Therapeutics
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Summary

Although cytotoxic chemotherapy is not fully established as an accepted part of the primary management of head and neck cancer, numerous studies over the past 10 years have been undertaken, notably in the USA and Europe. Several classes of antineoplastic chemotherapy have activity and can induce tumour regression in patients with squamous or anaplastic cancers, the most common cell types. While response rates with newer combinations, such as cisplatin and fluorouracil, are reportedly as high as 90%, response duration is generally short-lived. The most promising use of chemotherapy appears to be synchronous or adjuvant therapy with radiotherapy and/or surgery. Combined modality therapy of this type is able to improve the local control rates; 2 prospectively randomised studies from the United Kingdom each with several hundred patients have suggested a possible improvement in overall survival as well.

The most active agents are methotrexate, cisplatin, bleomycin and fluorouracil. Further studies are urgently needed to assess the true role of and the indications for chemotherapy, and because of the world-wide importance of these tumours, the identification of even a modest improvement would have profound benefit. The use of chemotherapy outside studies should still be discouraged.

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References

  • Al-Sarraf M. New approaches to the management of head and neck cancer: the role of chemotherapy. Advances in Oncology 6(3): 11–14, 1990

    Google Scholar 

  • Al-Sarraf M, Weaver A, Peppard S, et al. High dose cisplatinum and 5-fluorouracil infusion as part of a multi-disciplinary therapeutic approach for advanced previously untreated epidermoid cancers of the head and neck. Abstract. International Head and Neck Oncology Research Conference 2: 15, 1980

    Google Scholar 

  • American Joint Committee for Cancer Staging and End Result Reporting. Manual for staging of cancer. American Cancer Society, Chicago, 1978

    Google Scholar 

  • Bertino JR, Boston B, Capizzi RL. The role of chemotherapy in the management of cancer of the head and neck: a review. Cancer 36: 752–759 1975

    Article  PubMed  CAS  Google Scholar 

  • Cancer Research Campaign. Fact sheet 9.4. Cancer Research Headquarters, London, 1988

  • Carter SK. The chemotherapy of head and neck cancer. Seminars in Oncology 4: 413–424 1977

    PubMed  CAS  Google Scholar 

  • De Andres Basauri L, Lopez Pousa A, Alba E, Sampedro F. Carboplatin, an active drug in advanced head and neck cancer. Cancer Treatment Reports 70: 1173–1179 1986

    PubMed  Google Scholar 

  • De Conti RC, Schoenfeld I. A randomized prospective comparison of intermittent methotrexate, methotrexate with leucovorin, and a methotrexate combination in head and neck cancer. Cancer 48: 1061–1072 1981

    Article  Google Scholar 

  • Dobrowsky W, Dobrowsky E, Strassl H, Braun O, Gritzmann N, et al. Combined modality treatment of advanced cancers of the oral cavity and oropharynx. International Journal of Radiation Oncology Biology Physics 20: 239–242 1991

    Article  CAS  Google Scholar 

  • Eschwege F, Sancho-Gamier H, Gerard JP, et al. Ten-year results of randomised trial comparing radiotherapy and concomitant bleomycin to radiotherapy alone in epidermoid carcinomas of the oropharynx: experience of the European Organization for Research and Treatment of Cancer. National Cancer Institute Monograph 6: 275–278 1988

    Google Scholar 

  • Fu KK, Phillips TL, Silverberg IY, et al. Combined radiotherapy and chemotherapy with bleomycin and methotrexate for advanced inoperable head and neck cancer: update of a Northern California Oncology Group randomised trial. Journal of Clinical Oncology 5: 1410–1418 1987

    PubMed  CAS  Google Scholar 

  • Gupta NL, Pointon RCS, Wilkinson PM. A randomized clinical trial to contrast radiotherapy with radiotherapy and methotrexate given synchronously in head and neck cancer. Clinical Radiology 38: 575–581 1987

    Article  PubMed  CAS  Google Scholar 

  • Head and Neck Contracts Program (USA). Adjuvant chemotherapy for advanced head and neck squamous cell carcinoma. Cancer 60: 301–311, 1987

    Article  Google Scholar 

  • Hong WK, Bromer R. Chemotherapy in head and neck cancer. New England Journal of Medicine 308: 75–79 1983

    Article  PubMed  CAS  Google Scholar 

  • Hong WK, Schaefer S, Issell B, et al. A prospective randomized trial of methotrexate versus cisplatin in the treatment of recurrent squamous cell carcinoma of the head and neck. Abstract. Proceedings of the American Society of Clinical Oncology 1: 202, 1982

    Google Scholar 

  • Iscoe N. Chemotherapy of head and neck cancer. Journal of Clinical Oncology 5: 575–593 1986

    Google Scholar 

  • Jacobs C. Adjuvant chemotherapy for head and neck cancer. Journal of Clinical Oncology 7: 823–825 1989

    PubMed  CAS  Google Scholar 

  • Jacobs C. The internist in the management of head and neck cancer. Annals of Internal Medicine 113: 771–778 1990

    PubMed  CAS  Google Scholar 

  • Japanese Cancer Association. Fundamental and clinical studies of bleomycin. Carter SK et al. (Eds) GANN monograph in cancer research, no. 19, University Park Press, Baltimore, 1976

    Google Scholar 

  • Kish JA, Ensley JF, Jacobs J, et al. A randomized trial of cisplatin plus 5-fluorouracil infusion and cisplatin plus 5-fluorouracil bolus for recurrent and advanced squamous cell carcinoma of the head and neck. Cancer 56: 2740, 1985

    Article  PubMed  CAS  Google Scholar 

  • Krakoff IH, Cvitkovic E, Currie V, Yeh S, LaMonte C. Clinical pharmacologic and therapeutic studies of bleomycin given by continuous infusion. Cancer 40: 2027–2037 1977

    Article  PubMed  CAS  Google Scholar 

  • Leone LA, Al Bala MM, Rege VB. Treatment of carcinoma of the head and neck with intravenous methotrexate. Cancer 21: 828–837 1968

    Article  PubMed  CAS  Google Scholar 

  • Levitt M, Mosher MB, DeConti RC, et al. Improved therapeutic index of methotrexate with ‘leucovorin rescue’. Cancer Research 33: 1729–1734 1973

    PubMed  CAS  Google Scholar 

  • Lo TC, Wiley Jr AL, Ansfield FJ, et al. Combined radiation therapy and 5-fluorouracil for advanced squamous cell carcinoma of the oral cavity and oropharynx: a randomized study. American Journal of Roentology 126: 229–235 1976

    CAS  Google Scholar 

  • MacMillan CH, Carrick K, Bradley PJ, Morgan DAL. Concomitant chemo/radiotherapy for advanced carcinoma of the head and neck. British Journal of Radiology 64: 941–946 1991

    Article  PubMed  CAS  Google Scholar 

  • Million RR, Cassisi NJ, Wittes RE. Cancer of the head and neck. In DeVita Jr VT et al. (Eds) Cancer: principles and practice of oncology, 2nd ed., pp. 407–506, Lippincott, Philadelphia, 1985

    Google Scholar 

  • Milne RJ, Heel RC. Ondansetron: therapeutic use as an emetic. Drugs 41: 574–595 1991

    Article  PubMed  CAS  Google Scholar 

  • O’Connor AD, Clifford P, Dailey VM, Durden-Smith DJ, Edwards WG, et al. Advanced head and neck cancer treated by combined radiotherapy and VBM cytotoxic regimen: four year results. Clinical Otolaryngology 4: 325–337 1979

    Google Scholar 

  • Schuller DE, Metch B, Mattox D, et al. Pre-operative chemotherapy in advanced resectable head and neck cancer: final report of the South West Oncology Group. Laryngoscope 98: 1205–1211 1988

    Article  PubMed  CAS  Google Scholar 

  • SECOG Participants. A randomized trial of combined multi-drug chemotherapy and radiotherapy in advanced squamous cell carcinoma of the head and neck. European Journal of Surgical Oncology 12: 289–295, 1986

    Google Scholar 

  • SECOG Participants. The SECOG trials in advanced head and neck cancer. Comparison of sequentially and synchronously timed regimens and the role of 5-fluorouracil. British Journal of Cancer, in press, 1992

    Google Scholar 

  • Shanta V, Krishnamurthi S. Combined bleomycin and radiotherapy in oral cancer. Clinical Radiology 31: 617–620 1980

    Article  PubMed  CAS  Google Scholar 

  • Shedd DP. Cancer of the head and neck. In Holland JF & Frei E (Eds) Cancer medicine, pp. 1437–1449, Lea and Febiger, Philadelphia, 1973

    Google Scholar 

  • Souhami RL, Tobias JS. Cancer and its management, Blackwell Scientific, Oxford, 1986

    Google Scholar 

  • Steel GG, Peckham MJ. Exploitable mechanisms in combined radiotherapy/chemotherapy: the concept of additivity. International Journal of Radiation Oncology Biology Physics 5: 85–91 1979

    Article  CAS  Google Scholar 

  • Stell PM, Rawson NSB. Adjuvant chemotherapy in head and neck cancer. British Journal of Cancer 61: 779–787 1990

    Article  PubMed  CAS  Google Scholar 

  • Tannock IF, Browman G. Lack of evidence of the role of chemotherapy in the routine management of locally advanced head and neck cancer. Journal of Clinical Oncology 4: 1121–1126 1986

    PubMed  CAS  Google Scholar 

  • Taylor SG, Murthy AK, Caldarelli DD, et al. Combined simultaneous cisplatin/fluorouracil chemotherapy and split course radiation in head and neck cancer. Journal of Clinical Oncology 7: 846–856 1989

    PubMed  Google Scholar 

  • Taylor SG, Murthy AK, Showel JL. Improved control in advanced head and neck cancer with simultaneous radiation and cisplatin/5-Fu chemotherapy. Cancer Treatment Reports 69: 938–939 1985

    Google Scholar 

  • Tobias JS. Has chemotherapy proved itself in head and neck cancer? British Journal of Cancer 61: 649–651, 1990

    Article  PubMed  CAS  Google Scholar 

  • Tobias JS. UKCCCR randomised study of chemo-radiotherapy in advanced head and neck carcinoma. Clinical Oncology 3: 306–309 1991

    Article  PubMed  CAS  Google Scholar 

  • Tobias JS, Smith BJ, Blackman G, Finn G. Concurrent daily cisplatin and radiotherapy in locally advanced squamous carcinoma of the head-and-neck and bronchus. Radiotherapy and Oncology 9: 263–268 1987

    Article  PubMed  CAS  Google Scholar 

  • Toohill RJ, Anderson T, Byhardt RW, et al. Cisplatin and fluorouracil as neoadjuvant therapy in head and neck cancer. Archives of Otolaryngology — Head and Neck Surgery 113: 758–761 1987a

    Article  PubMed  CAS  Google Scholar 

  • Toohill RJ, Duncavage JA, Grossman TW, et al. The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies. Laryngoscope 97: 407–412 1987b

    Article  PubMed  CAS  Google Scholar 

  • United Kingdom Coordinating Committee for Cancer Research (UKCCCR). Head and neck collaborative group: UKHAN 1. A trial of chemotherapy with radiotherapy in the treatment of advanced squamous carcinoma of the head and neck. Available from J Houghton, CRC Trials Centre, 123 Coldharbour Lane, London SE5, 1991

  • Veteran Affairs Laryngeal Cancer Study group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. New England Journal of Medicine 324: 1685–1690, 1991

    Article  Google Scholar 

  • Vokes EE. Concomitant chemoradiotherapy for head and neck cancer. Advances in Oncology 6(3): 24–29, 1990

    Google Scholar 

  • Vokes EE, Dimery IW, Jacobs CD, Karp D, Molina A, et al. A phase II study of piritrexim in combination with methotrexate in recurrent and metastatic head and neck cancer. Cancer 67: 2253–2257 1991

    Article  PubMed  CAS  Google Scholar 

  • Vokes EE, Moran WJ, Mick R, Weichselbaum RR, Panje WR. Neoadjuvant and adjuvant methotrexate, cisplatin and fluorouracil in multi-nodal therapy of head and neck cancer. Journal of Clinical Oncology 7: 838–845 1989

    PubMed  CAS  Google Scholar 

  • Vokes EE, Weichselbaum RR. Concomitant chemoradiotherapy: rationale and clinical experience in patients with solid tumors. Journal of Clinical Oncology 8: 911–934 1990

    PubMed  CAS  Google Scholar 

  • Wagstaff AJ, Ward A, Benfield PA, Heel RC. Carboplatin: a preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of cancer. Drugs 37: 162–190 1989

    Article  PubMed  CAS  Google Scholar 

  • Weissberg JB, Son YH, Papac RJ, et al. Randomized clinical trial of mitomycin-C as an adjunct to radiotherapy in head and neck cancer. International Journal of Radiation Oncology Biology Physics 17: 3–9, 1989

    Article  CAS  Google Scholar 

  • Wittes RE, Cvitkovic E, Shah J, Gerold FP, Strong EW. Cis-dichlorodiammine platinum (II) in the treatment of epidermoid carcinoma of the head and neck. Cancer Treatment Reports 61: 359–366 1988

    Google Scholar 

  • Woods RL, Fox RM, Tattersall MHN. Methotrexate treatment of squamous cell head and neck cancers: dose-response evaluation. British Medical Journal 282: 600–602 1981

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Radiotherapy and Oncology, University College Hospital, Gower Street, London, WC1E 6AU, England

    J. S. Tobias

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Tobias, J.S. Current Role of Chemotherapy in Head and Neck Cancer. Drugs 43, 333–345 (1992). https://doi.org/10.2165/00003495-199243030-00004

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