DNA analysis as a predictor of the outcome of induction chemotherapy in advanced head and neck carcinomas
J. Tennvall, J. Wennerberg, H. Anderson, B. Baldetorp, M. Ferno and R. Willen
Department of Oncology, University Hospital, Lund, Sweden.
We investigated whether flow cytometric DNA index and/or ploidy status are
predictors of response to chemotherapy and survival. Fifty consecutive
patients with previously untreated locally advanced squamous cell
carcinomas of the head and neck received induction chemotherapy consisting
of three courses of cisplatin (100 mg/m2) and a subsequent 120-hour
infusion of fluorouracil (1000 mg/m2 per 24 hours) repeated every 3 weeks.
Chemotherapy was followed by radiotherapy to a median target dose of 65 Gy
and subsequent surgery for residual tumor. The median observation time was
27 months (range, 24 to 57 months). Flow cytometric DNA analysis was based
on formalin-fixed and paraffin-embedded tissue from pretreatment tumor
biopsy specimens. Complete response after induction chemotherapy was
achieved in only 12% (2/17) of patients with diploid tumors compared with
39% (13/33) of those with nondiploid tumors. Among patients with nondiploid
tumors, DNA index was higher for those responding to chemotherapy compared
with the nonresponders. Complete response to chemotherapy was apparently a
prerequisite for survival in the nondiploid group. Of the patients not
responding to chemotherapy but responding to subsequent radiotherapy,
survival was better among those with diploid tumors than among those with
nondiploid tumors.
