The CancerWeb Report, What's New In Cancer: January, 1997
Head and Neck Cancer

• c-erbB-2, a prognostic factor for oral cancer - Researchers at the M.D. Anderson Cancer Center in Houston reported that levels of the oncogene c-erbB-2 (also called HER-2/neu), measured by a computerized system, correlate with poor survival in patients with squamous cell cancer of the mouth. This study, based on patients in Shanghai, China, was reported in the January, 1997 issue of Clinical Cancer Research. Among 80 patients from whom specimens were obtained, 41 had high levels of expression of c-erbB-2, and the doctors were able to relate survival to amount of the oncogene in 39 patients. 5-year survivals were 100% for low or no expression, 90% for intermediate, and 10% for high levels of expression. (Xia, Clin Cancer Res 3:3, 1997)

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• Mitomycin as a safe and effective adjunct to radiotherapy for head and neck cancer - Mitomycin is one of the older chemotherapy drugs which might offer advantages if used in a new setting. It is selectively toxic to cells deficient in oxygen (hypoxic) and might therefore nicely complement radiation which is most effective against well-oxygenated cells. This concept was tried and found to be successful by researchers at Yale University in New Haven, Connecticut. The effect of mitomycin was potentiated by dicumarol in animal studies, and this drug was included in the second part of this trial, but there did not appear to be any clinical advantage, patient response being the same with or without dicumarol. Earlier reports on this trial have appeared, and the latest 138-month follow-up was published in the January, 1997 issue of the Journal of Clinical Oncology. After over 11 years, there was significant improvement in local recurrence-free survival (85% versus 66%) and local regional recurrence-free survival (76% versus 54%). (Haffty, J Clin Oncol 15:268, 1997)

  Editor's Comment: - Although overall survival was not significantly altered (48% versus 42%), it is important to stress the uniquely debilitating effects of local regional recurrence of head and neck cancers with respect to appearance, function, local infections and other complications, and overall quality of life. Any reduction or delay in such recurrence is extremely beneficial to patients even if their life-span is only marginally increased.

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• Chemoradiotherapy superior to radiotherapy alone for cancer of the esophagus - The prognosis for esophageal cancer, usually treated with surgery and/or radiation, has remained poor with an overall survival rate of less than 5%, although much better results are seen with more localized disease. Postoperative mortality is high, and this has led to efforts to develop effective chemotherapy. Results of a randomized intergroup trial by several US Cooperative Groups was published in the January, 1997 issue of the Journal of Clinical Oncology confirmed the superiority of chemoradiotherapy. The report represented the minimum follow-up of 5 years for 62 patients receiving radiation alone (64 Gy dose), versus 61 patients given a lower radiation dose (50 Gy) accompanied and followed by chemotherapy with cisplatin and 5-fluorouracil. Median survival duration and 5-year survival rates were 14 versus 9 months, and 27% versus 0% for the combined treatment and radiation alone groups. The promising interim results seen on earlier analysis of trial results, encouraged these researchers to use combined treatment on another group of patients 30% of whom were alive at 3 years with a median survival of 17 months. (Al-Sarraf, J Clin Oncol 15:277, 1997)