Albert Jortay

Preliminary results of a randomized E.O.R.T.C. study comparing radiotherapy and concomitant bleomycin to radiotherapy alone in epidermoid carcinomas of the oropharynx

The purpose of this randomized trial was to verify some experimental and clinical data suggesting a possible potentiating effect of bleomycin when used concomitantly with radiotherapy. Out of 220 patients with a biopsy proven epidermoid carcinoma of the oropharynx, 186 evaluable cases are reported here. One group of 87 patients was treated with radiotherapy alone (Cobalt 60 ∼ 6400 rad ∼ 7–8.5 weeks), the other group of 99 patients received radiotherapy combined with bleomycin, the latter administered at the dose of 15 mg i.m. twice a week for 5 weeks (total dose: 150 mg). Analysis of the treatment groups showed their comparability with regard to the most important prognostic factors (TNM, sites of primary, sex, age …). Complication rates of mucositis and epidermitis were significantly increased (71%) in the radiotherapy + bleomycin group and were considered responsible of frequent denutrition and weight loss in this group. Such side effects necessitated a delay of radiotherapy in 22% of patients and definitive interruption in 5% in the combined treatment group whereas in the radiotherapy alone group no interruption of treatment was recorded and only 5 treatments (6%) were postponed. Considering tumor regressions measured 6 weeks after completion of radiation therapy, total regression rates were not significantly different in both groups as far as primary tumor (67.9–67%) or neck nodes (49–62%) are concerned. Survival curves obtained by the actuarial method showed the same 50% survival in both groups at 15 months of follow-up.

Randomised EORTC Head and Neck Cooperative Group trial of preoperative intra-arterial chemotherapy in oral cavity and oropharynx carcinoma

Between February 1978 and January 1984, 222 eligible patients were randomised in a multicentre trial of preoperative intra-arterial chemotherapy in the treatment of oral cavity and oropharynx carcinoma. Patients were randomised between either surgery or preoperative chemotherapy. This latter group received vincristine and bleomycin for 12 days. Patients were stratified according to the primary site: floor of the mouth (FM) versus posterior oral cavity or oropharynx (POC) and institution. The FM group received postoperative radiotherapy depending upon quality of the margins and lymph-node pathological involvement, when it was systematically applied in the POC group. Tumour regression after chemotherapy either complete (CR) or partial (PR greater than 50%) was observed in 48% in the FM group and 41% in the POC group, and lymph-node regression (CR + PR) was respectively 15% and 23%. Some discrepancies appeared between clinical regression and pathological response, and the number of cases without histological response was clearly higher than the number of cases without clinical response. The overall survival showed a statistically significant difference (P = 0.048) between FM and POC groups. In the FM group, median survival in the chemotherapy arm was estimated at 7 years compared with 3 years in the surgery arm. In the POC group, median survival was estimated at 3 years in both treatment arms. Chemotherapy lowered the uncontrolled disease and local recurrence in the FM group. These differences do not exist in the POC group, which may be due to the systematically postoperative radiotherapy.

Adenylate cyclase and protein phosphokinase activities in human thyroid. Comparison of normal glands, hyperfunctional nodules and carcinomas

Abstract Basal and stimulated adenylate cyclase and protein phosphokinase activities were measured in normal and diseased human thyroids. Seven specimens of thyroid carcinomas (2 papillary, 2 mixed papillo-follicular or trabecular, 1 follicular and 2 medullary), and 6 hyperfunctional autonomous nodules were obtained at thyroidectomy. Nine specimens of normal tissue, taken from the opposite lobe of the nodular thyroids and from entirely normal glands, constituted the control group. Biochemical observations were the following: adenylate cyclase: basal activity and stimulation by TSH were rather similar in all cases. Hyperfunctional nodules were characterized by a significant increase of stimulation, as compared to the normal, by sodium fluoride (13·0 vs 7·8 fold) and prostaglandin E1 (2·6 vs 1·3 fold). Adrenalin had no significant effect. Protein phosphokinase: basal activity was significantly higher in carcinomas by a factor of up to 4-fold. Activation by cyclic AMP was similar in normal and pathological homogenates. These data show that adenylate cyclase activity is not unequivocally related to the degree of malignancy in human thyroid tumors and that protein phosphokinase activity is increased in such tissues. The data are discussed within the framework of current hypotheses derived from studies of transformed cells in vitro.

A randomized EORTC trial comparing intra-arterial infusion with methotrexate vs bleomycin as initial therapy in carcinoma of the oral cavity

Either intra-arterial infusions of MTX (500 mg over 10 days) or intra-arterial infusions of BLM (95 mg over 13 days) were administered as initial treatment to 85 patients with untreated squamous cell carcinomas of the oral cavity. Tumour regression was assessed 10-15 days after the end of chemotherapy. A sequential analysis was used, and BLM demonstrated a significantly greater local efficacy after the 32nd matched pair was assessed. The same results were observed when tumour response rates were compared, ignoring the matching, on the 85 patients, (P less than 0.001). The response rate for patients with neck nodes was low (10/38). Catheter management problems, toxic effects and lethal reactions were 2.5 times more frequent in the MTX group.

Regional chemotherapy of maxillofacial malignant melanoma with intracarotid artery infusion of DTIC

Six intracarotid artery infusions of DTIC were performed in 4 patients with invasive malignant melanoma of the maxillo-facial region. A total dose of 3.5 to 7 g was well tolerated. Only 1 patient who received 9.5 g in 25 days developed a reversible bone marrow depletion. Two out of the 4 patients presented a transient 50 % tumor surface regression, but no response was seen after the second infusion. Of the 2 remaining patients, 1 had no measurable effect and 1 experienced tumor progression.

An Unusual Case of Squamous Cell Carcinoma of the Nose

A 49-year-old man presented with a tumoral lesion of the tip of the nose which had been manifest for 2 months. Within a few weeks, the tumour increased in size and became infiltrated. The biopsy showed a squamous cell carcinoma. Treatment consisted of a radical surgical excision.