s-1-(combination) and Oropharyngeal-Neoplasms

A subgroup of oropharyngeal squamous cell carcinoma (OPC) is infected with high-risk human papillomavirus (HPV). The object of this study is to evaluate the efficacy of adjuvant chemotherapy with S-1, an oral 5-fluorouracil prodrug, on survival of patients with OPC according to HPV status.. Among OPC patients of stage III or IV who received definitive treatment from 1998 to 2008, 38 who were confirmed tumor-free after primary treatment were analyzed. Before 2003, none of the patients received S-1 adjuvant chemotherapy (S-1(-)-group); however, all patients who were eligible were administered S-1 (S-1(+)-group) after 2003. The expression of thymidylate synthase (TYMS) involved in 5-FU metabolism was also examined in protein and mRNA levels.. Although there was a trend to disease-free and overall survival benefit in HPV-negative patients with S-1, it did not achieve statistical significance (P=.082 and P=.065, respectively). For the HPV-positive patients, the survivals were similar with or without S-1 administration. TYMS-expression in HPV-positive OPC tissues was significantly higher than in HPV-negative ones in both protein and mRNA levels (P=.0489 and P=.0446, respectively).. The current study provides a rationale to plan a randomized trial to compare the efficacy of S-1 according to the HPV status in OPCs.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Drug Therapy, Combination; Female; Fluorouracil; Humans; Immunohistochemistry; Male; Oropharyngeal Neoplasms; Oxonic Acid; Papillomaviridae; Prodrugs; Retrospective Studies; Tegafur; Treatment Outcome

S-1 is an oral fluoropyrimidine. The purpose of this study was to review the clinical outcomes of S-1 with concurrent radiotherapy for patients with oropharyngeal cancer.. Between 2002 and 2007, 38 patients with oropharyngeal cancer treated concurrently with S-1 and definitive radiotherapy were reviewed. The clinical stage was Stage I in 4 patients, Stage II in 7, Stage III in 7, and Stage IV in 20. S-1 was administered orally twice daily for 4 consecutive weeks followed by a 2-week drug withdrawal. The initial dose of S-1 was 65 mg/m(2)/day. All patients were treated using three-dimensional conformal radiotherapy with a median total dose of 65.1 Gy (range, 60.0-71.0 Gy). Clinical outcomes and major acute toxicities were analyzed based on medical records and clinical follow-up.. With a median follow-up time of 33 months, the 3-year estimates of local-regional control, distant metastases-free survival, disease-free survival, and overall survival for all patients were 75%, 80%, 65%, and 80%, respectively. The 3-year estimates of local-regional control according to stage were 100% for Stages I and II, 86% for Stage III, and 56% for Stage IV. The rate of ≥ Grade 3 acute mucositis was 32%, and the rate of ≥ Grade 3 hematological toxicities was 8%. No other severe toxicities were observed.. Concurrent chemoradiotherapy with S-1 was found to be effective, especially for early disease. The treatment-related toxicities were acceptable, and the incidence of myelotoxicity was low. Further study must be carried out to compare with other chemotherapy regimens.

Topics: Adult; Aged; Aged, 80 and over; Drug Combinations; Female; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Oxonic Acid; Radiotherapy, Adjuvant; Radiotherapy, Conformal; Survival Analysis; Survival Rate; Tegafur; Treatment Outcome

Radiotherapy (RT) and chemoradiotherapy (CRT) is widely accepted as the standard treatment for head and neck cancer (HNC). Oral mucositis (OM) often develops as an adverse reaction in HNC patients that receive RT or CRT involving S-1. However, little is known about the risk factors for OM in HNC patients. We retrospectively evaluated patients' pre-treatment clinical data in order to identify the risk factors for severe OM in HNC patients that are treated with RT or CRT involving S-1. We analyzed the cases of 129 patients who received RT or CRT involving S-1 for HNC. The endpoint of the survey was the occurrence of severe OM (≥grade 2). Risk factors that were significantly related to severe OM were identified using logistic regression analysis. The patients' mean age was 69.3±10.1 years, and 118 (92%) of the patients were male. The primary tumor was located in the oropharynx in 21.7% of cases. Severe OM occurred in 85.0% of cases. In the univariate analysis, the following variables were found to be associated with severe OM: age, the type of radiotherapy, disease stage, and chemotherapy. In the multivariate analysis, the location of the primary tumor and chemotherapy were identified as significant risk factors that contributed independently to the risk of severe OM (p<0.05). Our analysis suggests that cancer of the oropharynx and CRT are important risk factors for severe OM in HNC patients that undergo RT or CRT involving S-1.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy; Drug Combinations; Female; Head and Neck Neoplasms; Humans; Logistic Models; Male; Middle Aged; Oropharyngeal Neoplasms; Oxonic Acid; Radiotherapy; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Stomatitis; Tegafur

We reported the efficacy of concurrent chemoradiotherapy(CCRT)for cervical lymph node metastasis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma. The subjects were 17 patients with oropharyngeal or hypopharyngeal cancer with cervical lymph node metastasis, who underwent CCRT treatment between January 2005 and December 2009. The proportion of patients showing a complete response(CR)was 64. 7%; however, if patients without any residual viable cancer cells in the specimens obtained by neck dissection were also defined as CR, then, 82. 4% achieved CR. Thus, CCRT showed good efficacy without the need for planned neck dissection(PND). The limited recurrence cases and absence of serious complications associated with neck dissection after CCRT suggested that PND is not necessarily required. However, since assessment of cervical lymph nodes after CCRT is difficult, it would be desirable to develop a reliable examination and to study the most suitable examination for detecting the presence/absence of cervical lymph node metastasis.

Topics: Adult; Aged; Aminohydrolases; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Female; Humans; Hypopharyngeal Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neck; Oropharyngeal Neoplasms; Oxonic Acid; Tegafur

Various treatments for oropharynx cancer included radiotherapy, arterial injection chemotherapy (as well as combined chemoradiotherapy), combined concurrent chemoradiotherapy, and surgical resection and reconstruction. There are also treatment differences among facilities. Our department has been providing a treatment modality for head and neck malignancies with the aims of functional and morphological preservation with a high cure rate. We herein report the treatment efficacy in 7 cases of oropharynx cancer (6 cases on lateral wall and 1 case on superior wall)treated with S-1, nedaplatin and radiotherapy (SN therapy) at our department between April 2006 and December 2006. The total of 7 cases included 1 case of T1N1M0, 1 of T2N0M0, 2 of T2N2bM0, 1 of T2N2cM0, 1 of T3N2cM0, and 1 case of T4N2cM0. The patients were all male and their ages ranged from 57 to 76 years old, with the average age of 68.4 years. Six of the 7 cases are surviving without cancer through treatment and their functions and morphologies have been preserved. In the 1 case of T4N2cM0, the tumor did not disappear and the patient expired due to the original lesion. Although SN therapy supposedly enables functional and morphological preservation, it is necessary to increase the number of cases and examine the efficacy of SN therapy for oropharynx cancer for functional and morphological preservation and the survival rate.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Humans; Male; Middle Aged; Organoplatinum Compounds; Oropharyngeal Neoplasms; Oxonic Acid; Tegafur

We administered TS-1 to a patient with advanced oropharyngeal carcinoma who underwent a gastrostomy because of swallowing difficulties. TS-1 was dissolved in 50 degrees C water and administered through a gastrostogavage tube. The pharmacokinetics of TS-1 were then investigated. The plasma 5-FU level was measured, and adverse events appearing after administration were monitored. The highest plasma 5-FU concentration on day 1 was 138.7 ng/ml; this level was obtained in a sample drawn 2 hours after the administration of TS-1. The highest plasma 5-FU concentration of TS-1 on day 8 (159.8 ng/ml) was also drawn 2 hours after the administration of TS-1. No major adverse events were observed in the patient. In particular, no toxic effects on the digestive systems were observed. Furthermore, the administration of TS-1 through a gastrostomy was safe. Such a procedure could also be used in patients with naso-gastric feeding tubes. We conclude that the administration of TS-1 through either a gastrostomy or a naso-gastric feeding tube may be a new administration method that can improve the quality of life (QOL) of patients with advanced and/or recurrent head and neck carcinoma.

Topics: Deglutition Disorders; Drug Administration Schedule; Drug Combinations; Fluorouracil; Gas Chromatography-Mass Spectrometry; Gastrostomy; Humans; Informed Consent; Intubation, Gastrointestinal; Male; Middle Aged; Oropharyngeal Neoplasms; Oxonic Acid; Pyridines; Tegafur

We report a recent case of squamous cell carcinoma originating in the right tonsil, with metastasis to the right superior cervical lymph nodes (T3N2bM0: stage IVA). Chemo-radiotherapy was administered as first-line therapy; and adjuvant chemotherapy with TS-1 was applied during the subsequent 4-week period for the treatment of the residual tumor in the neck. In this patient (female, 61 years old), the primary tonsillar tumor showed a complete response to the first-line therapy, however, the metastatic lesions in the cervical lymph nodes persisted, although the nodes also decreased markedly in size. Subsequent chemotherapy with TS-1 (80 mg/day) given for a 4-week period resulted in complete disappearance of the residual malignancy (CR), as determined by palpation and diagnostic imaging. No serious adverse events occurred during the therapy. Surgical treatment in patients with advanced head and neck cancer often results in a diminished quality of life. Although further accumulation of cases is necessary, TS-1, which allows oral chemotherapy on an outpatient basis, would seem to be a useful drug for adjuvant chemotherapy following radical irradiation in patients with advanced head and neck cancer.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Combined Modality Therapy; Drug Combinations; Female; Humans; Lymphatic Metastasis; Middle Aged; Oropharyngeal Neoplasms; Oxonic Acid; Pyridines; Tegafur

A 60-year-old man had a recurrence of squamous cell carcinoma at the right side of the tongue base. Chemotherapy with TS-1 (100 mg/day) was begun. Each course of chemotherapy consisted of 4 weeks of TS-1, followed by 2 weeks of no treatment. After the completion of two courses, macroscopic examination revealed a complete response. From the third course of TS-1 treatment, the dose was increased to 120 mg/day. The complete response persisted on macroscopic examination. A biopsy done during the ninth course of TS-1 treatment confirmed the complete response histologically, with no evidence of malignancy. After 12 courses of TS-1 treatment, the drug was switched to 600 mg/day of UFT. Although there were no signs or symptoms of recurrence, the patient died of cancer of the pancreas. There was no recurrence of the oropharyngeal cancer, even at the time of death.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Squamous Cell; Drug Administration Schedule; Drug Combinations; Humans; Male; Middle Aged; Oropharyngeal Neoplasms; Oxonic Acid; Pyridines; Remission Induction; Tegafur