Conclusion

Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

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Despite more than three decades of experience with chemotherapy, no undisputed role for its use has been established. In metastatic disease, the role is purely palliative, but chemotherapy benefits a small minority, and only for a brief duration. Whether the use of multiple agents is more beneficial than the use of single agents alone remains controversial, and until higher and more lasting response rates can be achieved, its widespread use is hard to justify outside the context of clinical trials.

Some cures are possible, however, with the use of concomitant chemotherapy and radiation for advanced, unre-sectable locoregional disease at initial presentation or when recurrent. In this setting, superiority over either palliative chemotherapy or radiation alone has recently been demonstrated in randomized trials, but ideal protocols have yet to be established. In primary resectable disease, there is a definite indication for the use of chemotherapy as a neoadjuvant therapy in organ preservation protocols.

Although not yet standard therapy, induction chemotherapy for organ preservation should at least be considered a standard treatment option. This use is still not widespread, and an answer to the debate over whether the benefits seen can be attributed to radiotherapy alone is still pending. Induction chemotherapy has not achieved the important goal of improved survival. With the current therapies available, the best hope for improved survival is by improving rates of locoregional disease. The greatest promise has been achieved using concomitant chemo- and radiotherapy, with benefits repeatedly demonstrated in both primary and recurrent disease. Whether this approach is superior to neoadjuvant chemotherapy is the subject of ongoing multicenter studies.

The use ofintra-arterial drug delivery also shows promise in the improvement of locoregional control, but whether long-term survival is improved by this approach remains to be established.

A need to control systemic disease and the development of second primary tumors also exists. Success depends not so much on the development of new agents, but on the development of new methods of delivering effective drugs selectively to systemic tumor in such a way that normal tissues are minimally affected. Such targeted systemic therapy will depend on advances in tumor genetics and immunology, which are currently the subject of intensive research.

A final controversy that remains, when success with chemotherapy is achieved, is whether complicated protocols from specialized cancer centers can be made available in settings outside such centers, to benefit larger numbers of patients.

REFERENCES

Shannon and Robbins—CHAPTER 9

1. Vikram B, Strong EW, Shah JP, et al. Failure at distant sites following multimodality therapy for advanced head and neck cancer. Head Neck Surg 1984;6:730-733

2. Kramer S, Gelber RD, Snow JB, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group. Head Neck Surg 1987;10:49-55

3. Hong WK, Bromer R. Chemotherapy in head and neck cancer. N Engl J Med 1984;308:75-79

4. Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med 1993;328:184-194

5. Morton RP, Fugman F, Dorman EB, et al. Cisplatin and bleomycin for advanced or recurrent squamous cell carcinoma of the head and neck: a randomized factorial phase III controlled trial. Cancer Chemother Pharmacol 1985;15:283-289

6. Vogl SE, Schonfeld DA, Kaplan BH, et al. A randomized prospective comparison of methotrexate with a combination of methotrexate, bleomycin and cisplatin in head and neck cancer. Cancer 1985;56:432-442

7. Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus fluorouracil versus carboplatin plus fluorouracil versus methotrexate in advanced squamous cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 1992;10:1245-1251

8. Jacobs C, Lyman G, Velez-Garcia E, et al. A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 1992;10:257-263

9. Clavel M, Vermorken JB, Cognetti F, et al. Randomized comparison of cisplatin, methotrexate, bleomycin, and vincristine versus cisplatin and 5-fluorouracil versus cisplatin in recurrent or metastatic squamous cell cancer of the head and neck. Ann Oncol 1994;5:521-526

10. Browman GP, Cronin L. Standard chemotherapy in squamous cell head and neck cancer: what we have learned from randomized trials. Semin Oncol 1994;21:311-319

11. Boussen H, Cvitkovic E, Wendting JL, et al. Chemotherapy of metastatic and/or recurrent undifferentiated nasopharyngeal carcinoma with cisplatin, bleomycin and fluorouracil. J Clin Oncol 1991;9:1675-1681

12. Choo R, Tannock I. Chemotherapy for recurrent or metasta-tic carcinoma of the nasopharynx: a review of the Princess Margaret Hospital experience. Cancer 1991;68:2120-2124

13. Fandi A, Altun M, Azli N, et al. Nasopharyngeal cancer: epidemiology, staging, and treatment. Semin Oncol 1994;21: 382-397

14. Head and Neck Contracts Program. Adjuvant chemotherapy for advanced head and neck squamous carcinoma: final report of the Head and Neck Contracts Program. Cancer 1987;60: 301-311

15. Rentschler RE, Wilbur DW, Petti GH, et al. Adjuvant methotrexate escalated to toxicity for resectable stage III and

IV squamous head and neck carcinomas: a prospective randomized study. J Clin Oncol 1987;5:278-275

16. Schuller DE, Wilson HE, Smith RE, et al. Preoperative chemotherapy in advanced resectable head and neck cancer: final report of the Southwest Oncology Group. Laryngoscope 1988;98:1205-1211

17. Jortay A, Demard F, Dalesio O, et al. A randomized EORTC study on the effect of preoperative polychemotherapy in pyri-form sinus carcinoma treated by pharyngolaryngectomy and irradiation: results from 5 to 10 years. Acta Chir Belg 1990;90: 115-122

18. Richard JM, Kramar A, Molinari R, et al. Randomised EORTC head and neck cooperative group trial of preoperative intra-arterial chemotherapy in oral cavity and oropharynx carcinomas. Eur J Cancer 1991;27:821-827

19. The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685-1690

20. Laramore GE, Scott CB, Al-Sarraf M, et al. Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: report of the Intergroup study 0034. Int J Radiat Oncol Biol Phys 1992;23:705-713

21. Hong WK, Lippman SM, Wolf GT. Recent advances in head and neck cancer—larynx preservation and cancer chemopre-vention: the seventeenth annual Richard and Hinda Rosenthal Foundation award lecture. Cancer Res 1993;53:5113-5120

22. Wolf GT, Hong WK. Induction chemotherapy for organ preservation in advanced laryngeal cancer: is there a role? Head Neck 1995;17:279-283

23. Jacobs C, Makuch R. Efficacy of adjuvant chemotherapy for patients with resectable head and neck cancer: a subset analysis of the Head and Neck Contracts Program. J Clin Oncol 1990;8:838-847

24. Toohill RJ, Duncavage JA, Grossman TW, et al. The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies. Laryngoscope 1987;97: 407-412

25. Okura M, Hiranuma T, Adachi T, et al. Induction chemotherapy is associated with an increase in the incidence of locore-gional recurrence in patients with carcinoma of the oral cavity: results from a single institution. Cancer 1998;82:804-815

26. Stell PM, Dalby JE, Stisckland P, et al. Sequential chemotherapy and radiotherapy in advanced head and neck cancer. Clin Radiol 1983;34:463

27. Lefebvre J-L, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst 1996;88:890-899

28. Shah JP, Karnell LH, Hoffman HT, et al. Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg 1997;123:475-483

29. Harwood AR, Hawkins NV, Beale FA, et al. Management of advanced glottic cancer: a 10-year review of the Toronto experience. Int J Radiat Oncol Biol Phys 1979;5(6):899-904

30. Mendenhall WM, Parsons JT, Stringer SP, et al. Stage T3 squamous cell carcinoma of the glottic larynx: a comparison of laryngectomy and irradiation. Int J Radiat Oncol Biol Phys 1992;23:725-732

31. Domenge C, Marandas P, Vignoud J, et al. Post-surgical adjuvant chemotherapy in extracapsular spread invaded lymph node (N+ R+) of epidermoid carcinoma of the head and neck: a randomized multicentric trial. In: Second International Conference on Head and Neck Cancer 1988:74

32. Rossi A, Molinari R, Boracchi P, et al. Adjuvant chemotherapy with vincristine, cyclophosphamide, and doxorubicin after radiotherapy in local-regional nasopharyngeal cancer: results of a 4-year multicenter randomized study. J Clin Oncol 1988; 6:1401-1410

33. Ervin TJ, Clark JR, Weichselbaum RR, et al. An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous cell cancers of the head and neck. J Clin Oncol 1987;5:10-20

34. Bitter K. Postoperative chemotherapy versus postoperative cobalt 60 radiation in patients with advanced oral cavity carcinoma: report on a randomized study. Head Neck Surg 1981;3:264

35. Forastiere AA. Randomized trials of induction chemotherapy. A critical review. Hematol Oncol Clin North Am 1991;5:725-736

36. Steel GG, Peckham MJ. Exploitable mechanisms in combined radiotherapy-chemotherapy: the concept of additivity. Int J Radiat Oncol Biol Phys 1979;5:85-91

37. Fu KK. Biological basis for the interaction of chemotherapeu-tic agents and radiation therapy. Cancer 1985;55:2123-2130

38. El-Sayed S, Nelson N. Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region: a meta-analysis of prospective and randomized trials. J Clin Oncol 1996;14:838-847

39. Bourhis J, Pignon JP, Designe L, et al. Meta-analysis of chemotherapy in head and neck cancer: locoregional treatment vs same treatment plus chemotherapy. In: American Society of Clinical Oncology Thirty-fourth Annual Meeting 1998:386a

40. Taylor SG. Integration of chemotherapy into the combined modality therapy of head and neck squamous cancer. Int J Radiat Oncol Biol Phys 1987;13:779-783

41. Merlano M, Grimaldi A, Bernasso M, et al. Alternating cisplatin-5-fluorouracil and radiotherapy in head and neck cancer. Am J Clin Oncol 1988;11:538-542

42. Merlano M, Vitale V, Rosso R, et al. Treatment of advanced squamous cell carcinoma of the head and neck with alternating chemotherapy and radiotherapy. N Engl J Med 1992;327: 1115-1121

43. Al-Sarraf M, LeBlanc M, Shanker Giri PG, et al. Chemotherapy versus radiotherapy in patients with advanced nasopha-ryngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998;16:1310-1317

44. Chan ATC, Teo PML, Leung TWC, Johnson PJ. The role of chemotherapy in the management of nasopharyngeal carcinoma. Cancer 1998;82:1003-1012

45. Haffty BG, Son YH, Sasaki CT, et al. Mitomycin C as an adjunct to postoperative radiotherapy in squamous cell carci noma of the head and neck: results from two randomized clinical trials. Int J Radiat Oncol Biol Phys 1993;27:241-250

46. Bachaud JM, Cohen-Jonathon E, Alzieu C, et al. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck cancer: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996;36: 999-1004

47. Adelstein DJ, Rice TW, Becker M, et al. Use of concurrent chemotherapy, accelerated fractionation radiation, and surgery for patients with esophageal carcinoma. Cancer 1997;80: 1011-1120

48. Adelstein DJ, Lavertu P, Saxton JP, et al. Mature results of a phase III randomized trial comparing concurrent chemora-diotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer. Cancer 2000;88: 876-883

49. Adelstein DJ, Lavertu P, Saxton JP, Wood BG, Eliachar I, Larto MA. Is organ preservation appropriate for T4 larynx cancer? Head Neck 1998;20:444

50. Brizel DM, Albers ME, Fisher SR, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338:1798-1804

51. Wendt TG, Grabenbauer GG, Rodel CM, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol 1998;16:1318-1324

52. Harrison LB, Raben A, Pfister DG, et al. A prospective phase II trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck. Head Neck 1998;20:497-503

53. Calais G, Alfonsi M, Bardet E, et al. Randomized study comparing radiation alone (RT) versus RT with concomitant chemotherapy (CT) in stages III and IV oropharynx carcinoma. Preliminary results of the 94.01 study from the French Group of Radiation Oncology for Head and Neck Cancer. American Society of Clinical Oncology 1998:1484

54. de Serdio JL, Villar A, Martinez JC, et al. Chemotherapy as part of each treatment fraction in a twice-a-day hyperfraction ated schedule: a new chemoradiotherapy approach for advanced head and neck cancer. Head Neck 1998;20:489-496

55. De Crevoisier R, Bourhis J, Domenge C, et al. Full-dose reirradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients. J Clin Oncol 1998;16:3556-3562

56. Wheeler RH, Ziessman HA, Medvec BR, et al. Tumor blood flow and systemic shunting in patients receiving intraarterial chemotherapy for head and neck cancer. Cancer Res 1986;46:4200-4204

57. Grigoletto G, et al. Intra-arterial cisplatin in head and neck cancer: a phase I-II study. Proc Am Soc Clin Oncol 1982;23:198

58. Mortimer JE, Taylor ME, Schulman S, et al. Feasibility and efficacy of weekly intra-arterial cisplatin in locally advanced (stage III and IV) head and neck cancers. J Clin Oncol 1988; 6:969-975

59. Lee YY, Dimery IW, Van Tassel P, et al. Superselective intraarterial chemotherapy of advanced paranasal sinus tumors. Arch Otolaryngol Head Neck Surg 1989;115:503-511

60. Robbins KT, Storniolo AM, Kerber C, et al. Phase I study of highly selective supradose cisplatin infusions for advanced head and neck cancer. J Clin Oncol 1994;12:2113-2120

61. Eckman WW, Patlak CS, Fenstermacher JD. A critical evaluation of the principles governing the advantages of intra-arterial infusions. JPharmacokinet Biopharm 1974;2:257-285

62. Robbins KT, Storniolo AM, Kerber C, et al. Rapid superselective high-dose cisplatin infusion for advanced head and neck malignancies. Head Neck 1992;14:364-371

63. Robbins KT, Vicario D, Seagren S, et al. A targeted supradose cisplatin chemoradiation protocol for advanced head and neck cancer. Am J Surg 1994;168:419-422

64. Robbins KT, Fontanesi J, Wong FSH, et al. A novel organ preservation protocol for advanced carcinoma of the larynx and pharynx. Arch Otolaryngol Head Neck Surg 1996;122: 853-857

65. Shannon KF, Robertson J, Kumar P, Robbins KT. Targeted intra-arterial cisplatin and concurrent radiotherapy in the treatment of paranasal sinus cancer. Aust NZ J Surg 1998; 68(suppl):A83

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10 Ways To Fight Off Cancer

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Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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