Cisplatin and 5-fluorouracil as induction chemotherapy followed by radiation therapy in metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck. A phase II study.

12 patients with metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck were treated with induction chemotherapy and radiotherapy. Median age was 54 years (range, 39-68 years) and male to female ratio was 2:1. Five (42%) patients had N3 disease and 7 (58%) had N2 disease. Induction chemotherapy consisted of cisplatin 60 mg/m2, days 1 and 2 and 5-fluorouracil (5-FU), 500 mg/m2, days 3 and 4. Cycles were repeated every 4 weeks to a total of 3 cycles. After 4 weeks rest, patients underwent radiation therapy. It was given to all possible sites of the primary tumor (nasopharynx, pyriform sinus, and the base of the tongue). The radiation therapy dosage planned to the whole neck, nasopharynx, and supraclavicular area was 45 Gy in 24 daily fractions in 5 weeks, increasing to 60-70 Gy to the metastatic site. We observed 9 (75%) complete responses and 1 (8%) partial response. 7 (58%) patients are currently with no evidence of disease. Median survival time for all patients is 36 months (range, 14+ to 56 months), while median survival time for N3 patients was 32 months (range, 26-56 months). Toxicities were predominantly mild to moderate nausea and vomiting and mucositis. This combined modality appears to be effective and feasible in treatment of metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck.

Carboplatin and radiation therapy for stage IV carcinoma of the head and neck. Preliminary results of a phase II study.

34 patients with head and neck cancer were treated with carboplatin and radiation therapy. Eligibility criteria included stage IV biopsy-proven squamous cell carcinoma with measurable disease and no distant metastases, Karnofsky performance status score of 60 or greater, age 18 years or more, no previous radiation therapy and adequate hematological, renal, and hepatic function. There were 27 males and 7 females. Ages ranged from 44-70 years with a median of 57 years. Follow-up ranged from 11-34 months with a median of 21 months. Total tumor doses ranged from 50-55 Gy with additional boosts of 15-20 Gy. Carboplatin was given in a dose of 100 mg/m2 once weekly (26 patients) and 200 mg/m2 once every 2 weeks (8 patients), during the radiation therapy course in all 34 patients. Each dose of carboplatin preceded irradiation. 25 patients responded while 9 did not. There were 19 complete responses (CR) and 6 partial responses. 4/19 CR recurred and 5/9 non-responding patients died of disease. Mild to moderate nausea and vomiting were seen in 52.3% of patients and mucositis was seen in 61.8% of patients. Moderate to severe hematological toxicity was seen in 35.3% of patients. Response rates and toxicity we observed during this study clearly show that the combination of carboplatin and radiation therapy is effective and suitable for the treatment of patients with stage IV head and neck cancer.