[Radiotherapy of head-neck neoplasms: prevention of inflammation of the mucosa by sucralfate treatment]. / Strahlentherapie von Kopf-Hals-Malignomen: Entzündungsprophylaxe der Schleimhaut durch Sucralfatbehandlung.

The mucosal protective effect of sucralfate (Ulcogant) was evaluated in a prospective randomised clinical study during radiation therapy. Twenty-four patients received 1 g of a sucralfate suspension 4 times a day orally for 5 min each. This group was compared with a control group of 21 patients receiving standard oral hygiene consisting of frequent tooth cleaning and disinfection of the oral and pharyngeal mucosa. The radiation technique was telecobalt therapy in two opposing fields using the shrinking field technique, with an electron boost to the posterior lymph nodes; the dosage was 60-70 Gy in daily fractions of 2 Gy. Mucosal reactions, pain and difficulty in swallowing were recorded twice a week. We also checked the patient's weight during treatment. The patients showed significant differences in all parameters, and lower weight loss compared with the control group. Minimal or absent mucosal inflammation pain or dysphagia were found in 88%, 79% and 83% respectively, while 43% and 29% and 52% of the controls had such mild radiation side-effects. Local effectivity appeared to be less in the hypopharynx due to shorter time of application compared with mouth and oropharynx. There were no side-effects from the sucralfate. Sucralfate prophylaxis is effective and easy to apply in the protection of mucosa during irradiation therapy.

[Factors modifying remission in cytostatic chemotherapy of squamous cell carcinoma recurrence in the area of the head and neck]. / Remissionsbeeinflussende Faktoren der zytostatischen Chemotherapie beim Plattenepithelkarzinom-Rezidiv des Kopf-Hals-Bereiches.

From 1981 to 1986 eighty-five patients underwent palliative chemotherapeutic treatment at the E.N.T. Department of the University Hospital in Graz. In seventy-three recurrent tumours comparable RR were achieved with ADM/CDDP as well as with MTX/5-FU. In 39 patients a second treatment after failure or relapse of previous therapy was applied, containing predominantly CDDP/BLM resulting in a RR of 18%. The tumour stage proved to be the single most important factor concerning response to treatment in first as well as second line chemotherapy. Stage IV tumours showed a significantly lower RR compared to neoplasms without large neck masses (stages II, III), the RR being 59% versus 19% (p = 0.01). Furthermore, performance status, preceding therapeutical modalities, and location of the tumours were shown to be of secondary prognostic importance. In the latter group, age and the time interval between recurrences appeared to be of no significance. To evaluate the most effective regimen, highly differentiated analysis of all available data is imperative.

[Chemotherapy of recurrent squamous cell carcinomas in the ENT area with cisplatin/adriamycin (DDP/ADM) and methotrexate/5-fluorouracil (MTX/5-Flu): a retrospective comparison of 2 protocols]. / Chemotherapie rezidivierender Plattenepithelkarzinome des HNO-Bereiches mit Cis-Platin/Adriamycin (DDP/ADM) und Methotrexat/5-Fluorouracil (MTX/5-Fu): retrospektiver Vergleich zweier Protokolle.

The efficacy of two chemotherapy regimens for recurrent and inoperable squamous cell carcinoma of the head and neck is reported. All patients had failed prior surgery and/or radiotherapy. 23 patients (group A) were treated with Cisplatin 120 mg/m2 and Adriamycin 60 mg/m2. 21/23 were evaluable for tumour response. The overall response rate (RR) was 28.5% (6/21, 2 CR and 4 PR). Methotrexate 250 mg/m2 with Leucovorin-Rescue 5 X 10 mg/m2 and 5-Fluorouracil 600 mg/m2 were administered to 28 patients. In 26 evaluable patients a RR of 38.4% (10/26, 5 CR and 5 PR) was achieved. The responders in groups A and B had a median survival of 98 and 85.5 weeks respectively and the non-responders 27 weeks in both groups. Nausea, vomiting and alopecia were common and severe in the DDP/ADM group. The major toxic effect of MTX/5-FU was neutropenia with two associated deaths from septicemia, although subjective side-effects were almost completely absent. MTX/5-FU can be recommended for the palliative treatment of recurrent squamous head and neck cancer because of an acceptable response rate, good subjective tolerance and the possibility of outpatient treatment.

[Initial results of hyperthermia in palliative therapy of cancers in the ENT area]. / Erste Ergebnisse der Hyperthermie in der Palliativtherapie von Karzinomen im HNO-Bereich.

Preliminary results of an interdisciplinary study, conducted to investigate the efficacy of combined local hyperthermia and radiation/chemotherapy on carcinoma of head and neck, are reported. Upto now, eleven patients with recurrent squamous cell carcinoma of head and neck were treated, all of them had loco-regional recurrence, and 2 distant metastases in addition. 7 patients were pretreated by surgery and radiotherapy, 4 by radiotherapy only, and 6 by chemotherapy. Microwave-induced low-dose local hyperthermia was combined with radiotherapy (telecobalt 1100-2400 rad) 6 cases (group A) and with chemotherapy (bleomycin and cis-platin/bleomycin) in 5 patients (group B). Intratumoural temperatures between 43 and 45 degrees C were achieved for at least 30 minutes. The loco-regional efficacy of hyperthermia was assessed. 10/11 patients with 13 tumours could be evaluated, Group A: 3 CR, 4 PR, Group B: 1 PR, 4 MR and 1 NC.

[Therapy of recurrent squamous cell cancers in the ENT area with the sequential methotrexate (MTX)/5-fluorouracil (5-Fu) protocol]. / Therapie rezidivierender Plattenepithelkarzinome (rPECHN) im HNO-Bereich mit einem sequentiellen Methotrexat-(MTX)/5-Fluorouracil (5-Fu)-Protokoll.

MTX 250 mg./m2 was administered via i.v. push, followed 1 hour later by a 5-Fu 600 mg./m2 i.v. push. 24 hours after methotrexate, oral leucovorin-rescue started with 15 mg. Every 6 hours for a total of 5 doses. The courses were repeated at weekly intervals, if the toxicity permitted such repetition. 28 patients could be evaluated for response. The overall response rate was 39.2%, with 17.8% (5/28) complete response. The mean duration of complete and partial remissions was 30,8 and 24 weeks, respectively. Subjectively, the patients tolerated the treatment very well. Objective toxicity was moderate, and the major side effect was a generally mild myelosuppression. Thus, in our experience, this regimen can be recommended in the palliative treatment of rSCCHN.

[Palliative chemotherapy of recurring squamous cell carcinomas of the ENT field with the combination cis-diamminodichloroplatinum (II)/adriamycin]. / Palliative Chemotherapie rezidivierender Plattenepithelkarzinome des HNO-Bereiches mit der Kombination cis-Diamminodichloroplatinum (II)/Adriamycin.

23 patients with recurrent squamous cell carcinoma of head and neck (SCCHN) were treated with a combination of cisplatin 120 mg/m2 and adriamycin 60 mg/m2, both administered by I.V. infusion over 4 hours and 15 minutes, respectively, at day 1. The courses were repeated at 3-weeks interval. Hydration and diuresis forced via mannitol were much lower than usual with such high doses of cisplatin. All patients were intensively pretreated by surgery and/or radiotherapy, further local treatment being impossible; all had loco-regional recurrence, 2 distant metastases additionally. 21/23 patients could be evaluated, 6/21 objective responses (2 CR, 4 PR, RR = 28,5%) were seen, in 7/21 patients a minor response was obtained. Objective toxicity, especially nephrotoxicity, was mild, the major effect being short-lasting severe nausea and vomiting. The results obtained with this regimen are comparable to data obtained by other chemotherapy programmes. However, in our opinion at the moment the subjective toxicity seems too severe to recommend this regime for palliative treatment of recurrent SCCHN. Possibly the cisplatin-induced vomiting can be avoided or at least diminished by high doses of metoclopramid.

[Initial experiences with a new treatment protocol in otorhinolaryngologic cancers]. / Erste Erfahrungen mit einem neuen Therapieprotokoll bei HNO-Tumoren.

A new combined modality treatment in advanced squamous cell carcinoma of the head and neck, is presented. It consists of surgery, or radiotherapy, followed by adjuvant chemotherapy with MTX and CF rescue, cis-DDP, Bleomycin, Cyclophosphamide, given sequentially. Toxic effects were not very severe and did not cause an interruption of therapy.