title: Improved survival for patients with advanced carcinoma of the head and neck treated with methotrexate-leucovorin prior to definitive radiotherapy or surgery.
abstract: Patients presenting with Stage III-IV squamous carcinoma of the head and neck often relapse following aggressive surgery and/or radiotherapy. In an attempt to increase survival in this high risk group of patients, HD-MTX, 3 gm./m2/dose, given weekly, was administered to 21 inoperable patients with Stage III/IV squamous carcinoma of head and neck prior to, and for 1 month after, definitive surgery and/or radiotherapy. Six of 11 patients (55%) who showed a significant response (greater than 50% reduction in tumor volume) to HD-MTX are alive and free of tumor greater than 38 months following treatment (p = 0.6) (Fisher Exact Test). Responder median survival is greater than 38 months while non-responder median survival is 15 months (p = .02) (Log Rank Test). For the entire treatment group, at a mean duration of 44.2 months following initiation of therapy, 7 patients (33%) remain alive and free of tumor. Patients responding to induction MTX-LCV more often become eligible for combined modality approach than did the non-responder group. This "downstaging" of the tumor prior to aggressive surgery or radiotherapy may be responsible for the increased survival rate seen in those patients who responded to MTX-LCV.
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage*; D008727:Methotrexate / Q000008:administration & dosage*
chemical_list: D002955:Leucovorin; D008727:Methotrexate