peplomycin and Paranasal-Sinus-Neoplasms

The long-term results and the preservation rate of maxillo-facial functions and structures were reviewed in 250 cases of maxillary sinus carcinoma which were treated at the Department of Otolaryngology of Keio University Hospital from 1957 to 1987, dividing them into 4 groups according to treatment modalities. The major treatment modalities of each group are as follows. I (1957-1966): Half of the cases underwent radical resection of the maxillo-facial region with or without postoperative irradiation. Preoperative intra-arterial chemotherapy was first introduced in 1963. II (1967-1973): Half of the cases received preoperative intra-arterial chemotherapy with bleomycin (BLM). III (1974-1981): The major treatment modalities consist of BLM ia + radiation----surgery and 5-FU ia + radiation. IV (1982-1987): Multidisciplinary treatment incorporating intra-arterial neoadjuvant chemotherapy mainly with cisplatin and peplomycin was performed. The 5-year survival rates of each group are as follows. I: 22%, II: 40%, III: 42%, IV: 55%. The 5-year survival rate was as high as 52% in cases treated with BLM ia followed by surgery in group II, but all cases underwent total maxillectomy. Meanwhile, in group IV, the 5-year survival rate was not only as high as 55%, but also the rate of total maxillectomy was quite low (18%). From these results, we realized that intra-arterial chemotherapy played an important role for improving the long-term results and preserving the functions and structures in the treatment of maxillary sinus carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carcinoma, Squamous Cell; Cisplatin; Combined Modality Therapy; Evaluation Studies as Topic; Female; Fluorouracil; Humans; Infusions, Intra-Arterial; Male; Maxillary Sinus Neoplasms; Middle Aged; Paranasal Sinus Neoplasms; Peplomycin

The purpose of this paper is to present our preliminary assessment of a new multimodal treatment including neoadjuvant chemotherapy with cisplatinum and peplomycin for maxillary sinus carcinoma. Fifteen patients with squamous cell carcinoma of the maxillary sinus carcinoma seen at Keio University Hospital, with Stage III and IV disease, were enrolled in this trial between January 1982 and January 1985. Regimen of chemotherapy was as follows: day 1, 50 mg/m2 of cisplatinum, intraarterial infusion over 2 hr, days 2-6, peplomycin at a dose of 5 mg/day, intraarterial infusion over 5 hr. Routinely, radiotherapy of 40 Gy by Linac was given to the primary site, concomitantly combined with 5-fluorouracil intraarterial injections only during the first 10 days, 2 weeks after the end of initial chemotherapy. Additional treatment was performed according to the extent of residual tumor. Response to initial chemotherapy revealed that complete response was achieved in 7 and partial response in 6 out of 15 patients with a response rate of 87%. Nine patients required no surgical intervention while 6 underwent a surgical resection. Median follow-up in this group of patients is 20 months. Thirty-month survival rate calculated by Kaplan-Meier's method was 83%. Chemotherapy toxicity was mild in most cases. This pilot study does not provide conclusive survival information, but the results obtained are encouraging.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Female; Humans; Infusions, Intra-Arterial; Male; Maxillary Sinus Neoplasms; Middle Aged; Paranasal Sinus Neoplasms; Peplomycin