Failure of alkylating agents to improve induction chemotherapy of oropharyngeal squamous cell cancer.
BACKGROUND
This prospective semi-randomized study was undertaken to assess the effects and effectiveness of alkylating drugs in a preoperative setting.


METHODS
During a 6-year period preceding February 2000, 80 patients with Stage II-IVa (AJCC 2002) squamous cell cancer of the oral cavity were treated. Thirty patients (Group N) received a combination of bleomycin, vincristine and methotrexate (BVM). In the alkylating group, thirty patients (Group A/M) received BVM and mitolactol (dibromodulcitol), while twenty patients (Group A/C) received BVM and cisplatin. Patients underwent surgery within 3 weeks after chemotherapy. Clinical response rate and tumour-free survival were investigated.


RESULTS
Clinical complete response was 30%-36% (Group N-A). Partial response was 57%-56% (Group N-A). Side-effects were moderate and reversible. Nausea, anaemia and leucopenia were observed in the alkylating (A) group, while other side-effects (alopecia, mucositis, gastritis) were similar in both groups. The observation time was 36 months. Regional disease-free survival showed a significant difference, favouring the non-alkylating (N) group (p=0.03). A higher metastasis rate was observed in the alkylating (A) group.


CONCLUSIONS
Cisplatin and mitolactol in combination with BVM showed higher local control and lower disease-free survival than BVM alone. That was mostly due to a higher rate of regional metastatis formation in the alkylating-treated patients. This may be a late side-effect caused by the immunosuppressive and myelosuppressive effect of alkylating agents.
Olasz
Lajos
L
Department of Oral and Maxillofacial Surgery, University Pécs, Dischka Gy. u 5., Pécs H-7621, Hungary. lajos.olasz@aok.pte.hu
Nyárády
Zoltán
Z
Németh
Arpád
A
Királyfalvi
László
L
Ember
István
I
D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D008936:Mitolactol / Q000008:administration & dosage / Q000009:adverse effects; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D018906:Antineoplastic Agents, Alkylating; D001761:Bleomycin; D014750:Vincristine; D008936:Mitolactol; D002945:Cisplatin; D008727:Methotrexate