The impact of combined therapeutic modalities in head, neck, and esophageal cancer.

Nearly 50% of head and neck cancers and two-thirds of patients with esophageal cancer generally present late for initial treatment. The patterns of failure are generally locoregional with around 10% showing distant dissemination. Surgery alone and in combination with pre-operative radiation has not significantly increased salvage in these groups of cancer. The availability of increasingly effective drugs (Cisplatinum, MTX., Bleomycin), for head, neck and esophageal cancers have produced dramatic initial responses with excellent palliative relief of symptoms enabling adequate definitive radiotherapy or surgery for advanced T3, T4 lesions. Cisplatinum 20 mg/m2 daily X 5 - twice at the interval of 10 days with MTX 25 mg/m2 and Bleomycin 15 mg/m2 weekly X 2 have been used for T3 and T4 Head and Neck Cancers and Cisplatinum in the same dosage and MTX 200 mg twice in 10 days have been used for esophageal cancers. 88% responses in 35 patients have been noted in head and neck cancers and when the chemotherapy was followed by definitive radiotherapy, complete responses were achieved in 16 out of 25 patients (64%). This is a very significant response rate for T3, T4 cancers. Patients who were in a reasonably acceptable general condition after this regimen were further considered for two more courses of consolidative chemotherapy. Response rates in esophageal cancer was 78% (26 of 34 evaluable patients) - 6 of the 26 showed a complete response and all are alive from 8 months to 26 months. Our failure to obtain increasing cures at 3 and 5 years may be due to our ignorance of the capacity of dormant cells to proliferate, tumor cell kinetics, more effective use of chemotherapy or the biology of the host. These areas need further investigation.