Naoyuki Kohno

Neoadjuvant chemotherapy in maxillary sinus carcinoma with cisplatinum and peplomycin intraarterial infusion.

The purpose of this paper is to present our preliminary assessment of a new multimodal treatment including neoadjuvant chemotherapy with cisplatinum and peplomycin for maxillary sinus carcinoma. Fifteen patients with squamous cell carcinoma of the maxillary sinus carcinoma seen at Keio University Hospital, with Stage III and IV disease, were enrolled in this trial between January 1982 and January 1985. Regimen of chemotherapy was as follows: day 1, 50 mg/m2 of cisplatinum, intraarterial infusion over 2 hr, days 2-6, peplomycin at a dose of 5 mg/day, intraarterial infusion over 5 hr. Routinely, radiotherapy of 40 Gy by Linac was given to the primary site, concomitantly combined with 5-fluorouracil intraarterial injections only during the first 10 days, 2 weeks after the end of initial chemotherapy. Additional treatment was performed according to the extent of residual tumor. Response to initial chemotherapy revealed that complete response was achieved in 7 and partial response in 6 out of 15 patients with a response rate of 87%. Nine patients required no surgical intervention while 6 underwent a surgical resection. Median follow-up in this group of patients is 20 months. Thirty-month survival rate calculated by Kaplan-Meiers method was 83%. Chemotherapy toxicity was mild in most cases. This pilot study does not provide conclusive survival information, but the results obtained are encouraging.

Combination Chemotherapy With Cisplatin and Peplomycin in Squamous Cell Carcinoma of the Head and Neck

Ninety-three patients with head and neck cancer were treated with combined cisplatin-peplomycin chemotherapy (CP therapy). Cisplatin (CDDP) 50 mg/m2 i.v. (intravenous) or i.a. (intraarterial) over 2 hr was given with hydration and mannitol diuresis on day 1. From day 2 through day 6, peplomycin (PEP) 5 mg/day was administered by 5-hr i.v. or i.a. infusion, or 24-hr continuous hypodermic injection. Of 85 who were evaluable, there were 22 complete responses or CR (26%) and 36 partial responses or PR (42%), with an overall response rate of 68%. Concerning of the route of administration, i.a. infusion obtained the higher CR and overall response rates than i.v. infusion. Effectiveness was clearly greater in previously untreated cases than in cases that had received some previous therapeutic modality. Looking at response in relation to the number of the courses, at least 2 courses of CP therapy are required. Side effects were recognized in 68 out of 87 evaluable cases (78%). Nausea and vomiting were the most common (62%). Renal toxicity was observed in 24% and was mostly transient. From the above results, it is considered that the CP therapy is effective, not only for the palliative treatment of advanced and recurrent cancer of the head and neck, but also as neo-adjuvant chemotherapy of stage III and IV cases.

Dynamic Movement of Air Tract Fluid in Lubrication of the Larynx During Phonation: A Basic Study Using Excised Canine Larynges and Experimental Air Tract Fluid by Means of X-Ray Stroboscope System

Experiments using excised canine larynges and experimental air tract fluid were conducted to clarify the movement of air tract fluid in association with vocal fold vibration by means of X-ray stroboscope system. It was thought that the movement of air tract fluid in lubricating of the larynx during phonation was closely correlated to vocal fold vibration, especially the wave motion of the mucous membrane of the vocal folds and the movement of air tract fluid on the glottis might be one of parameters to evaluate the flexibility of the mucous membrane of the vocal folds.

CLINICAL EXPERIENCE WITH BESTATIN IN HEAD AND NECK CANCER

Publisher Summary This chapter describes a clinical experience with bestatin in head and neck cancer. In the study, bestatin was administered orally daily to 13 patients in combination with chemotherapy or to the other 7 patients after a radical operation or radiotherapy. In a group of patients, the effect of bestatin as an adjuvant immunotherapy was examined. Bestatin 60 mg/patient was administered daily orally after the tumor was considered to be grossly eliminated by radical operation, or irradiation as shown in II. This has been tried on seven cases. No recurrence was observed, although the period of the observation was too short to make any conclusion. Bestatin was used simultaneously with monochemotherapy or polychemotherapy in 13 cases. The results suggested that bestatin enhanced the effect of chemotherapy. Laboratory data indicated that the decrease in white cells or lymphocytes was relatively slight despite considerably heavy chemotherapy. The tuberculin reaction was not diminished in a few cases, suggesting that bestatin enhanced the delayed-type hypersensitivity.

Serum Complement Levels in Patients with Head and Neck Cancer

Complement level and tuberculin reactivity were measured as possible indices of the humoral and cell-mediated immune status of 167 patients with head and neck cancer examined at the Department of Otorhinolaryngology, Keio University School of Medicine, Tokyo, between July 1974 and June 1979. Complement level (CH 50 ) was measured according to Mayers method. In tuberculin tests, 0.1 ml of purified protein-derivative solution (0.5 μg/ml) was injected intracutaneously and formation of erythema and induration was measured 48 hr later. Results were analyzed according to the method of Nishioka, in which the following six stages were classified: stage 0, unaltered tuberculin reactivity and depressed complement level; stage I, unaltered tuberculin reactivity and normal complement level; stage II, unaltered tuberculin reactivity and elevated complement level; stage III, depressed tuberculin reactivity and elevated complement level; stage IV, depressed tuberculin reactivity and normal complement level; stage V, depressed tuberculin reactivity and depressed complement level. Patients were divided into seven different groups: pre-treatment, postradiotherapy, post-surgery, remission, 5-year survival, recurrence and metastasis, and terminal. Complement level was elevated in tumorbearing hosts, meanwhile it was within the normal range in non-tumor bearing hosts. Values of tuberculin reactivity and CH 50 were averaged within each group and analyzed as described above. The results of this study demonstrate that the complement system is elevated while the cell-mediated immune system is depressed in patients with malignant tumors. Thus, this classification system may prove clinically useful in planning treatment of cancer patients and in estimating their prognosis.