CONCOMITANT RADIOTHERAPY WITH MITOMYCIN-C AND BLEOMYCIN COMPARED WITHRADIOTHERAPY ALONE IN INOPERABLE HEAD AND NECK-CANCER - FINAL REPORT

Purpose: To compare the efficacy of concomitant irradiation with mitom ycin C and bleomycin in patients with inoperable head and neck carcino ma with radiotherapy alone. Methods and materials: Between March 1991 and December 1993, 64 patients with inoperable head and neck carcinoma (41 with oropharyngeal site) were randomized to radiotherapy alone (g roup A) or radiotherapy combined with simultaneous application of mito mycin C and bleomycin (group B), In both groups patients were irradiat ed five times weekly with 2 Gy to a fetal dose of 66-70 Gy, The planne d concomitant treatment in group B was: bleomycin 5 units twice a week IM, total dose 70 units, mitomycin C 15 mg/m(2) IV after delivery of 10 Gy, and 10 mg/m(2) IV on the last day of radiotherapy. To enhance t he effect of these two drugs, patients received also nicotinamide, chl orpromazine, and dicoumarol, Because significantly better results were achieved in arm B for patients with inoperable oropharyngeal carcinom a, the study was closed and such patients were after December 1993 rou tinely treated with the combined therapy (as in arm B), Until October 1996, we treated and followed up 48 such consecutive patients.Results: Median follow-up of our study patients is 42 months, Complete remissi on (CR) rate in group A was 31% and in group B 59% (p = 0.04); disease -free survival (DFS) in group A was 8% and in group B 37% (P = 0.01); and overall survival (OS) was 7% in group A and 26% in group B (p = 0. 08), CR rate for patients with oropharyngeal carcinoma was 29% in grou p A (N = 21) and 75% in group B (N = 20) (p = 0.007); DFS in group A w as 10% and in group B 48% (p = 0.001); and the OS was 10% in group A a nd 38% in group B (p = 0.019), In patients with inoperable oropharynge al carcinoma treated after December 1993, complete remission was achie ved in 32/48 (67%, 95% CI: 52%-80%). DFS at the median follow-up of 14 months was 60% (95% CI 43-77%) and OS 58% (95% CI 42-74%). Conclusion : From the results of our study it seems that the concomitant treatmen t significantly improves CR rate, DFS, and OS in patients with inopera ble oropharyngeal carcinoma in comparison with radiotherapy alone. (C) 1998 Elsevier Science Inc.