The impact of combined therapeutic modalities in head, neck, and esophageal cancer

P. B. Desai, J. J. Vyas, S. Sharma, S. H. Advani, R. Gopal, T. K. Saikia, K. A. Dinshaw, J. M. Pinto, Santhi Swaroop Vege

Research output: Contribution to journalArticle

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Abstract

Nearly 50% of head and neck cancers and two-thirds of patients with esophageal cancer generally present late for initial treatment. The patterns of failure are generally locoregional with around 10% showing distant dissemination. Surgery alone and in combination with pre-operative radiation has not significantly increased salvage in these groups of cancer. The availability of increasingly effective drugs (Cisplatinum, MTX., Bleomycin), for head, neck and esophageal cancers have produced dramatic initial responses with excellent palliative relief of symptoms enabling adequate definitive radiotherapy or surgery for advanced T3, T4 lesions. Cisplatinum 20 mg/m2 daily x 5 - twice at the interval of 10 days with MTX 25 mg/m2 and Bleomycin 15 mg/m2 weekly x 2 have been used for T3 and T4 Head and Neck Cancers and Cisplatinum in the same dosage and MTX 200 mg twice in 10 days have been used for esophageal cancers. 88% responses in 35 patients have been noted in head and neck cancers and when the chemotherapy was followed by definitive radiotherapy, complete responses were achieved in 16 out of 25 patients (64%). This is a very significant response rate for T3, T4 cancers. Patients who were in a reasonably acceptable general condition after this regimen were further considered for two more courses of consolidative chemotherapy. Response rate in esophageal cancer was 78% (26 of 34 evaluable patients) - 6 of the 26 showed a complete response and all are alive from 8 months to 26 months. Our failure to obtain increasing cures at 3 and 5 years may be due to our ignorance of the capacity of dormant cells to proliferate, tumor cell kinetics, more effective use of chemotherapy or the biology of the host. These areas need further investigation.

Original languageEnglish (US)
Pages (from-to)116-131
Number of pages16
JournalSeminars in Surgical Oncology
Volume1
Issue number3
DOIs
StatePublished - 1985
Externally publishedYes

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Esophageal Neoplasms
Head and Neck Neoplasms
Bleomycin
Drug Therapy
Radiotherapy
Therapeutics
Neoplasms
Radiation
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The impact of combined therapeutic modalities in head, neck, and esophageal cancer. / Desai, P. B.; Vyas, J. J.; Sharma, S.; Advani, S. H.; Gopal, R.; Saikia, T. K.; Dinshaw, K. A.; Pinto, J. M.; Vege, Santhi Swaroop.

In: Seminars in Surgical Oncology, Vol. 1, No. 3, 1985, p. 116-131.

Research output: Contribution to journalArticle

Desai, PB, Vyas, JJ, Sharma, S, Advani, SH, Gopal, R, Saikia, TK, Dinshaw, KA, Pinto, JM & Vege, SS 1985, 'The impact of combined therapeutic modalities in head, neck, and esophageal cancer', Seminars in Surgical Oncology, vol. 1, no. 3, pp. 116-131. https://doi.org/10.1002/ssu.2980010303
Desai, P. B. ; Vyas, J. J. ; Sharma, S. ; Advani, S. H. ; Gopal, R. ; Saikia, T. K. ; Dinshaw, K. A. ; Pinto, J. M. ; Vege, Santhi Swaroop. / The impact of combined therapeutic modalities in head, neck, and esophageal cancer. In: Seminars in Surgical Oncology. 1985 ; Vol. 1, No. 3. pp. 116-131.
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AU - Desai, P. B.

AU - Vyas, J. J.

AU - Sharma, S.

AU - Advani, S. H.

AU - Gopal, R.

AU - Saikia, T. K.

AU - Dinshaw, K. A.

AU - Pinto, J. M.

AU - Vege, Santhi Swaroop

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N2 - Nearly 50% of head and neck cancers and two-thirds of patients with esophageal cancer generally present late for initial treatment. The patterns of failure are generally locoregional with around 10% showing distant dissemination. Surgery alone and in combination with pre-operative radiation has not significantly increased salvage in these groups of cancer. The availability of increasingly effective drugs (Cisplatinum, MTX., Bleomycin), for head, neck and esophageal cancers have produced dramatic initial responses with excellent palliative relief of symptoms enabling adequate definitive radiotherapy or surgery for advanced T3, T4 lesions. Cisplatinum 20 mg/m2 daily x 5 - twice at the interval of 10 days with MTX 25 mg/m2 and Bleomycin 15 mg/m2 weekly x 2 have been used for T3 and T4 Head and Neck Cancers and Cisplatinum in the same dosage and MTX 200 mg twice in 10 days have been used for esophageal cancers. 88% responses in 35 patients have been noted in head and neck cancers and when the chemotherapy was followed by definitive radiotherapy, complete responses were achieved in 16 out of 25 patients (64%). This is a very significant response rate for T3, T4 cancers. Patients who were in a reasonably acceptable general condition after this regimen were further considered for two more courses of consolidative chemotherapy. Response rate in esophageal cancer was 78% (26 of 34 evaluable patients) - 6 of the 26 showed a complete response and all are alive from 8 months to 26 months. Our failure to obtain increasing cures at 3 and 5 years may be due to our ignorance of the capacity of dormant cells to proliferate, tumor cell kinetics, more effective use of chemotherapy or the biology of the host. These areas need further investigation.

AB - Nearly 50% of head and neck cancers and two-thirds of patients with esophageal cancer generally present late for initial treatment. The patterns of failure are generally locoregional with around 10% showing distant dissemination. Surgery alone and in combination with pre-operative radiation has not significantly increased salvage in these groups of cancer. The availability of increasingly effective drugs (Cisplatinum, MTX., Bleomycin), for head, neck and esophageal cancers have produced dramatic initial responses with excellent palliative relief of symptoms enabling adequate definitive radiotherapy or surgery for advanced T3, T4 lesions. Cisplatinum 20 mg/m2 daily x 5 - twice at the interval of 10 days with MTX 25 mg/m2 and Bleomycin 15 mg/m2 weekly x 2 have been used for T3 and T4 Head and Neck Cancers and Cisplatinum in the same dosage and MTX 200 mg twice in 10 days have been used for esophageal cancers. 88% responses in 35 patients have been noted in head and neck cancers and when the chemotherapy was followed by definitive radiotherapy, complete responses were achieved in 16 out of 25 patients (64%). This is a very significant response rate for T3, T4 cancers. Patients who were in a reasonably acceptable general condition after this regimen were further considered for two more courses of consolidative chemotherapy. Response rate in esophageal cancer was 78% (26 of 34 evaluable patients) - 6 of the 26 showed a complete response and all are alive from 8 months to 26 months. Our failure to obtain increasing cures at 3 and 5 years may be due to our ignorance of the capacity of dormant cells to proliferate, tumor cell kinetics, more effective use of chemotherapy or the biology of the host. These areas need further investigation.

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