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Two-year Follow-up of a Pilot Project

Samuel G. Taylor, IV, MD; David E. Bytell, MD; William D. DeWys, MD; Edward Applebaum, MD; George A. Sisson, MD

Arch Otolaryngol. 1978;104(11):647-651.

Abstract
A series of 17 patients with stage III and IV head and neck cancer received three cycles of methotrexate and leucovorin calcium during an interval of two weeks prior to surgery and/or radiotherapy. The dosage of methotrexate was sequentially escalated to produce mucositis (the usual dose-limiting toxicity). All patients have been followed up for a minimum of two years (range, 24 to 44 months). Two recurrences and two second primary tumors occurred in seven patients with stage III cancer, and one recurrence and one postoperative death (pulmonary embolism) occurred in ten patients with stage IV cancer. Seventy-six percent of patients survived, with 71% disease free. Mucositis occurred in 88% but was transient and prevented oral fluid intake in only one patient. Bone marrow suppression was usually mild and did not delay surgery. Escalation of dosage was thought to be important in achieving these encouraging results. A controlled trial is under way to better define the degree of efficacy of this regimen of adjuvant chemotherapy.

(Arch Otolaryngol 104:647-651, 1978)

Author Affiliations
From the Section of Medical Oncology, Department of Medicine (Drs Taylor and DeWys), the Department of Otolaryngology and Maxillofacial Surgery (Drs Bytell, Applebaum, and Sisson), and the Cancer Center (Drs Taylor, Bytell, DeWys, Applebaum, and Sisson), Northwestern University Medical School, Chicago. Dr Taylor is now with Rush-Presbyterian-St Luke's Medical Center, Chicago.

Footnotes
Accepted for publication Oct 31, 1977.

Presented in part at the 13th annual meeting of the American Society of Clinical Oncology, Denver, March 1977.

Reprint requests to Section of Medical Oncology, Department of Medicine, Rush-Presbyterian-St Luke's Medical Center, 1725 W Harrison St, Chicago, IL 60612 (Dr Taylor).

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