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)
Taylor SG, Bytell DE, DeWys WD, Applebaum E, Sisson GA. Adjuvant Methotrexate and Leucovorin in Head and Neck Squamous CancerTwo-year Follow-up of a Pilot Project. Arch Otolaryngol. 1978;104(11):647–651. doi:10.1001/archotol.1978.00790110037010