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Chemotherapy may be used alone Or in combination with other modalities of treatment. M ost of the head and neck malignancies are squamous cell cancers and the drugs found effective are methotr e xate , cisplatin , bleomycin and 5-fluorouracil . Adriamycin has been used for certain non- squamous carcinomas (e.g. adenoid cystic carcinoma), and dacarbazine for melanomas. Lymphomas of the head and neck, both Hodgkin and non-Hodgkin types, are also treated by chemotherapy because of their multifocal origin and wide-spread involvement.

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Types of Chemotherapy 1 . Palliative chemotherapy . Cytotoxic drugs, singly or in combination are used to treat advanced, recurrent or metastatic disease with an aim to relieve the symptoms and to prolong life in some of them. 2. Adjuvant chemotherapy. Here chemotherapy is used before, during or after treatment with other modalities. • When used before surgery or radiation, it is called induction or anterior chemotherapy. It helps to reduce tumour burden and micro metastases that can occur at the time of surgery or in the period before radiation. • When used simultaneously with radiotherapy, it acts as a radio sensitizer to cells which are otherwise Radio resistant. • When used after surgery or radiation , it is called posterior chemotherapy and is aimed to cure m icrometastases

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Single Agent vs Multidrug Combination Therapy Methotrexate , cisplatin , bleomycin and 5-fluorouracil have been used as single agents in various dosage forms. They have also been used in combination with other drugs with the object to improve overall response rate and duration of response. A trend is emerging that combination of two or more drugs improves the response rate and definitely improves the quality of patient's life but it has failed to improve the duration of response .

Drugs Used in Cancer Therapy:

Drugs Used in Cancer Therapy 1 . Methotrexate Squamous cell cancer . Acute leukaemia lymphomas Dose : 40mg/ m2 i.v . weekly , high dose can be given with leucovorin rescue Side effects : Bone morrow suppression mucositis of oral and G.I. mucosa . Maculopapular rash . Renal and hepatic toxicity Remarks: Excreted via urine. Hydration and alkalinisation of and urine before after drug administration reduces the risk of complications. Liver function tests before use

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5-Fluorouracil Squamous cell (5- Fu ): Squamous cell cancers . Non squamous tumours of breast and G.I. tract Dose: 10-15 mg/kg i . v. doily. Not more than 1 g in single bolus for 4-5 days. Repeated at weekly intervals

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