Large intravenous dose of methotrexate and radiotherapy in the treatment of advanced oral cancers
Tepmongkol, P.
Journal of the Medical Association of Thailand 62(1): 17-25
1979
ISSN/ISBN: 0125-2208 PMID: 762478 Document Number: 4300
Fifty-eight advanced squamous cell carcinomas of the oral cavity (T3- T4 and NO- N3) were treated with methotrexate 50 mg administered intravenously, once weekly for 5 injections and then followed by irradiation to the full dose of 6 0006 500 rads in 6 weeks. Thirty patients with the same tumour extent, receiving radiation alone were randomized numerically for the control group. The result of combined therapy showed 54 out of 58 patients (93 per cent) effective on the basis of objective primary tumour response with methotrexate alone, and 28 patients (48 per cent) showed complete resolution of the tumour. For the nodal response, only 30 out of 56 patients (53.5 per cent) showed effective and only 6 of them (10.7 per cent) revealed complete nodal resolution. This different response of the primary tumour and regional lymph ' nodes was discussed. Generally following the third injection, the tumour resolution appeared nearly complete. At the end of treatment the response of both primary tumour and lymph nodes in the study group showed more definitely effective than of the control group. The complete tumour resolution and lymph nodes increased 48 and 10.7 per cent to 70.7 and 33.9 per cent respectively, whereas only 16.7 and 13.3 per cent were observed in the control group. The result was transitory and the mean of remission period was 8.5 months which was shorter than of the control group (13.6 months). The combined therapy did not improve the survival time but it was definitely beneficial to the patients in both objective and subjective improvement in the first two years. The patients tolerated the planned intravenous dose of methotrexate very well and no severe toxicity was noted. This study provided a strong clinical impression that methotrexate in large intravenous dose combined with irradiation could arrest, initially, many advanced oral cancers that might not be arrested with radiation alone.
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