Chemotherapy- and radiotherapy-induced mucositis in head and neck cancer patients: new trends in pathophysiology, prevention and treatment.

Mucositis is the intensity-limiting toxicity in the management of locally advanced non-resectable head and neck cancer with radiotherapy and chemotherapy. New radiation modalities (hyperfractionation and/or acceleration) as well as combined modality regimens in this situation induce higher rates of acute toxicity. Hyperfractionation, for example, allows higher control rates, with few late toxicities, but it slightly increases acute mucositis. The addition of chemotherapy introduces systemic toxicity and can exacerbate local tissue reactions when used concurrently with radiotherapy. Mucositis is recognized as the principal limiting factor to further treatment intensification. As local regional control and overall survival are related to dose-intensity in this case, further research into the assessment, analysis, prevention and treatment of mucosal toxicity is not only crucial to improvement in quality of life, but certainly also to improved rates of disease control. Several topical and systemic treatments are directed to the decrease and the acceptance of this acute toxicity, but few have shown a significant preventive effect. The efficacy of low-level laser therapy in the management of such toxicity could hence yield important developments with this method in the field of oncology.

Prognostic significance of computed tomography in tumors of the oral cavity and oropharynx treated with neoadjuvant chemotherapy.

BACKGROUND: Despite its high response rate, the use of neoadjuvant chemotherapy remains controversial. Pretherapeutic identification of subgroups of patients who are likely to respond to chemotherapy is of the utmost importance. PURPOSE: In this study, we have attempted to determine the relationship between specific radiological parameters and the response to neoadjuvant chemotherapy. In addition, we have determined if these parameters could yield prognostic information on recurrence and/or survival. PATIENTS AND METHODS: Fifty-four patients with a squamous cell carcinoma of the oral cavity or base of tongue who had had a contrast-enhanced CT scan and neoadjuvant chemotherapy were included in this analysis. All clinical, radiological, surgical, histological, and radiotherapeutical parameters as well as the follow-up data were analyzed by a chi-square test. The method of Kaplan-Meyer was used to determine disease-free intervals and crude survival. The log-rank method was used for testing differences in local failures and survival. RESULTS: Twenty-eight patients were classified as having isodense nodes and 20 patients as having hypodense nodes. Nodal density was not related to tumor size or primary site. N stage was not correlated with the density of the nodes. Patients with hypodense nodes had a significantly lower disease-free interval and survival than patients with isodense nodes. The relation between overall response to chemotherapy and the hypodensity of the nodes didn't reach a significant level. CONCLUSION: No relation was found between overall response to chemotherapy and N-stage or tumor density. Disease-free interval and crude survival was strongly related to response to chemotherapy.

[EGF receptor, a prognostic factor in epidermoid cancers of the upper aerodigestive tracts]. / Le récepteur d'EGF, facteur de pronostic dans les cancers épidermoïdes des voies aérodigestives supérieures.

EGFR was determined, before treatment; in tumors biopsies obtained from 109 consecutive patients with head and neck cancer (100 men and nine women), using iodine labelled recombinant EGF. The median age of the study population was 60 years. EGFR levels varied from 2 to 2302 fmol/mg membrane protein (median 71). There was a significant difference of distribution for EGFR levels between stages I and II tumors and stages III and IV tumors (P = 0.03). The EGFR cut-off value for overall survival was 120 fmol/mg protein and the median follow-up was 18 months (3-35) EGFR overexpression was associated with shorter relapse-free (P = 0.0125) and overall survival (P = 0.028). By multivariate analysis the only significant variables were EGFR for relapse-free survival and tumor staging and EGFR for overall survival. Analyzed in 60 patients treated by first-line chemotherapy CDDP-5FU, the longest survival was achieved for patients who had a complete response to chemotherapy and the lowest EGFR levels (P = 0.018). EGFR expression in the primary tumor allows survival among first line chemotherapy responder categories to be discriminated.