peplomycin and Hypopharyngeal-Neoplasms

In the treatment of head and neck carcinoma involving the carotid artery, resection of the carotid artery and direct reconstruction using a vein graft has commonly been employed to reduce the incidence of cerebral ischemic complications. But the procedure of carotid grafting itself carries the risk of preventing complete tumor clearance. And contamination due to salivary fistula, particularly in cases of meso or hypopharyngeal carcinoma, may result in graft rupture or thrombosis. To overcome these difficulties, the authors have developed a new surgical procedure, namely, a contralateral external carotid-middle cerebral artery bypass operation. This bypass system is designed at directly supplying the cerebral hemisphere on the carotid ligation side through a vein graft running entirely outside the cervical operative field. The vein graft is anastomosed end-to side to the external carotid artery of the opposite side. Then it is placed subcutaneously in front of the auricle, above the zygomatic arch, frontal subgaleal space and anastomosed end-to-side to the recipient artery, the ascending branch of the middle cerebral artery, in the Broca area of the carotid ligation side. The neck is incised almost the same manner as in parotidectomy, with a slightly longer cervical extension, and the scalp by bilateral coronal incision of Sutta. A frontotemporal osteoplastic craniotomy of the involved side is performed. The length of the saphenous vein used is about 50cm. This surgical procedure requires no transient internal or external shunt. The common carotid artery can be ligated safely after confirming good post-anastomotic bypass flow using an electro-magnetic blood flow meter.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carotid Artery, External; Cerebral Arteries; Cerebral Revascularization; Chemotherapy, Adjuvant; Cisplatin; Humans; Hypopharyngeal Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Peplomycin

Clinical results of cases of hypopharyngeal carcinoma treated from 1966 to 1990 at Kyushu University Hospital were investigated. In 1966-1972, all cases were treated with only radical operation. We used FAR therapy since 1972, and preoperative chemotherapy (CDDP and Peplomycin) in addition to FAR therapy since 1984. The crude five-year survival rate of the operative therapy-group (25 cases in 1966-1972) was 24%, and that of the FAR therapy-group with or without operation (47 cases in 1972-1980) was 38%. Although it was cumulative survival rate by Kaplan-Meier's method, the five-year survival rate of the group (16 cases in 1984-1990) treated with a combination of FAR therapy, preoperative-chemotherapy, and operation was 76%. The improvement in the survival rate and the role of preoperative treatment (FAR therapy and chemotherapy) are discussed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Fluorouracil; Humans; Hypopharyngeal Neoplasms; Hypopharynx; Lymph Node Excision; Peplomycin; Radiotherapy Dosage; Survival Rate; Vitamin A

This report concerns a 64-year-old male suffering from advanced hypopharyngeal cancer. This patient was treated with four courses of combination chemotherapy including VPCP (a combination of VCR, PEP, CDDP and PEP) regimen as neo-adjuvant chemotherapy. And radiotherapy was given as a secondary treatment; Linac. 60 Gy/6 weeks. He showed no tumor masses in the hypopharynx following this combination chemotherapy. No recurrence has been found under endoscopy for one year after the treatment with combination chemotherapy. It thus seems that neo-adjuvant chemotherapy prior to surgery and/or radiation including cisplatin, peplomycin and other agents is very useful as a multimodal treatment for cancer of the hypopharynx.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carcinoma, Squamous Cell; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Humans; Hypopharyngeal Neoplasms; Male; Middle Aged; Peplomycin; Pharyngeal Neoplasms; Remission Induction; Vincristine

Neo-adjuvant chemotherapy, followed by definitive surgery and/or radiotherapy was utilized in nine patients with carcinoma of the hypopharynx and cervical esophagus starting in December, 1983. They were treated with combination chemotherapies which included CDDP, PEP (BLM), and MTX. The patients' ages ranged from 52 to 70 years with an average of 57. The histologic types were all squamous cell carcinoma and performance status was 1 in all cases. There were 7 stage III and 2 stage IV. Of 9 patients, 3 showed complete response and 6 showed partial response of the primary tumor with an overall response rate of 100%. Of 8 patients, 3 showed complete response and 2 showed partial response of the metastatic node with an overall response rate of 62.5%. Toxic effects included alopecia in 9 patients, nausea/vomiting in 7, eczema in 4, RBC below 350 X 10(4)/mm3 in 5, WBC below 3000/mm3 in 1, peak serum creatinine above 2 mg/dl in 1. All patients except one with renal toxicity were able to start definitive treatment soon after chemotherapy, the primary and regional lesions being subsequently well controlled in all 9 patients. Neo-adjuvant chemotherapy appears to be very effective for the reduction of tumor bulk. This multidisciplinary therapy should be expected to increase survival rate.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carcinoma, Squamous Cell; Cisplatin; Drug Administration Schedule; Esophageal Neoplasms; Female; Humans; Hypopharyngeal Neoplasms; Lymphatic Metastasis; Male; Methotrexate; Middle Aged; Peplomycin; Pharyngeal Neoplasms