ADJUVANT CHEMOTHERAPY IN HEAD AND NECK-CANCER

被引:126
作者
STELL, PM [1 ]
RAWSON, NSB [1 ]
机构
[1] INST CANC RES, EPIDEMIOL SECT, SURREY SM2 5NG, ENGLAND
关键词
D O I
10.1038/bjc.1990.175
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
An overview is presented of 23 trials of adjuvant chemotherapy in squamous cell carcinoma of the head and neck. These were reviewed from the point of view of design of the trial, analysis of survival, response rates, meta-analysis, site of failure, toxicity and cost. The minimal increase in survival that could be detected ranged from 11 to 51%, with a median of 25%. No trial was big enough to detect the likely increase of survival, which is 5%. Many trials excluded some eligible patients before randomisation, the proportion being 21% in those series with details. A further 9% of treated patients were excluded from analysis. A response rate in four induction studies of 47% equated with a 6% increase in cancer mortality. Meta-analysis showed an insignificant overall improvement in cancer mortality of 0.5%. Induction chemotherapy, synchronous chemotherapy and induction/maintenance chemotherapy did not affect cancer mortality whereas synchronous/ maintenance therapy did. Cisplatinum, methotrexate, bleomycin, 5-FU and a variety of other regimens did not affect the death rate from cancer, but the combination of VBM significantly increased it. Neither single agent nor combination chemotherapy produced a significant reduction of cancer deaths. The rate of locoregional failure was significantly lower in the treated arms, whereas the metastatic rate was similar in both arms. Only three papers gave full details of toxicity with grading: these showed a high toxicity rate. The mortality rate from chemotherapy in nine series averaged 6.5%. © The MacMillan Press Ltd., 1990.
引用
收藏
页码:779 / 787
页数:9
相关论文
共 52 条
[11]   ADJUVANT INTRAVENOUS METHOTREXATE OR DEFINITIVE RADIOTHERAPY ALONE FOR ADVANCED SQUAMOUS CANCERS OF THE ORAL CAVITY, OROPHARYNX, SUPRAGLOTTIC LARYNX OR HYPOPHARYNX - CONCLUDING REPORT OF AN RTOG RANDOMIZED TRIAL ON 638 PATIENTS [J].
FAZEKAS, JT ;
SOMMER, C ;
KRAMER, S .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1980, 6 (05) :533-541
[12]  
Fleiss JL., 1981, STAT METHODS RATES P, V2
[13]  
FLETCHER GH, 1963, CANCER, V16, P355, DOI 10.1002/1097-0142(196303)16:3<355::AID-CNCR2820160310>3.0.CO
[14]  
2-L
[15]   MANAGEMENT OF ADVANCED STAGE SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK [J].
FORASTIERE, AA .
AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1986, 291 (06) :405-415
[16]   COMBINED RADIOTHERAPY AND CHEMOTHERAPY WITH BLEOMYCIN AND METHOTREXATE FOR ADVANCED INOPERABLE HEAD AND NECK-CANCER - UPDATE OF A NORTHERN CALIFORNIA ONCOLOGY GROUP RANDOMIZED TRIAL [J].
FU, KK ;
PHILLIPS, TL ;
SILVERBERG, IJ ;
JACOBS, C ;
GOFFINET, DR ;
CHUN, C ;
FRIEDMAN, MA ;
KOHLER, M ;
MCWHIRTER, K ;
CARTER, SK .
JOURNAL OF CLINICAL ONCOLOGY, 1987, 5 (09) :1410-1418
[17]  
GEORGE SL, 1984, CANCER CLIN TRIALS, P289
[18]   INTEGRATION OF CHEMOTHERAPY INTO A COMBINED MODALITY TREATMENT PLAN FOR HEAD AND NECK-CANCER - A REVIEW [J].
GLICK, JH ;
TAYLOR, SG .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1981, 7 (02) :229-242
[19]  
GOLLIN FF, 1972, AM J ROENTGENOL, V114, P83
[20]   A RANDOMIZED CLINICAL-TRIAL TO CONTRAST RADIOTHERAPY WITH RADIOTHERAPY AND METHOTREXATE GIVEN SYNCHRONOUSLY IN HEAD AND NECK-CANCER [J].
GUPTA, NK ;
POINTON, RCS ;
WILKINSON, PM .
CLINICAL RADIOLOGY, 1987, 38 (06) :575-581