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P0109 Dietary factors influencing stomach cancer incidence in Omani patients
Abstracts / 50 (2014) e1–e74
Kerala, India, c Department of Biostatistics, Amrita Institute of Medical Sciences & Research Centre, Kochi, Kerala, India Background: Advances in radiotherapy techniques have improved clinical outcomes, but have also lead to concerns over subsequent acute and late effects. Dysphagia is one such complication that has garnered much attention. This retrospective study, conducted at a tertiary cancer care centre, aimed to analyse swallowing profiles of patients with cancer of anterior two-thirds of tongue, who had undergone surgery and had received adjuvant radiation using either IMRT or 3D CRT, as a surrogate of dose received by dysphagia aspiration-related structures (DARS). Methods: The treatment plans of patients treated using IMRT and 3D CRT, from November 2011 to December 2012, were retrieved from the planning system. The swallowing structures (DARS), namely superior, middle and inferior constrictors, base of tongue, larynx with supraglottis, and length of oesophagus, included in treatment volume with cricopharyngeous muscle, were contoured according to RTOG guidelines. Dose volume histograms were generated for these. Constraint doses were statistically derived. University of Washington Head-and-Neck-related Quality-of-Life questions addressing swallowing was used to evaluate swallowing status of patients. Findings: A statistically significant subjective correlation was found to exist between doses of swallowing structures, especially the constrictor muscles, base of tongue, and the larynx. Statistically derived probable mean dose-constraints correlated clinically with swallowing status of patients. IMRT had a statistically significant advantage over 3D CRT, in terms of V30 (p = 0.051), V50 (p = 0.002), V60 (p = 0.002), and D80 (p = 0.023) for the swallowing structures taken together. The probable limiting dose for dysphagia was 63 Gy for the superior constrictor and base of tongue, and 55 Gy for the larynx. Interpretation: Our study predicted possible mean dose constraints for the superior constrictor, base of tongue, and larynx. Further prospective studies are required to confirm these findings. Dysphagia-optimised IMRT is needed to improve swallowing status and quality of life in these patients.
e39
or analine, including chemokines, growth factors, and neuropeptide. Different DPP4 expression status has been observed in malignant tumours, including colon, renal, and ovarian carcinoma. Data mining of the published dataset (GSE31684) identified that DPP4 is significantly upregulated in urothelial carcinoma of the urinary bladder. We therefore analysed the association of DPP4 expression and outcome in our well-characterised cohort of urothelial carcinoma. Methods: Laser capture microdissection coupled with real-time qRT-PCR was used to evaluate DPP4 transcript level in 20 urothelial carcinomas of the urinary bladder. DPP4 immunostaining was done on 340 cases of urothelial carcinoma of the upper urinary tract and 295 cases of urothelial carcinoma of the urinary bladder. The expression status of DPP4 was then correlated with various clincopathological factors, disease-specific survival (DSS), and metastasis-free survival (MeFS). Findings: DPP4 mRNA expression was significantly increased in urothelial carcinomas with higher pT status (p < 0.001). In both groups of urothelial carcinomas, increment of DPP4 immunoexpression was significantly associated with advanced pT stage (both p < 0.001), high histological grade (urothelial carcinoma of the upper urinary tract, p = 0.019), lymph node metastasis (urothelial carcinoma of the upper urinary tract, p < 0.001; urothelial carcinoma of the urinary bladder, p = 0.033), vascular invasion (both p < 0.001), perineurial invasion (urothelial carcinoma of the urinary bladder, p = 0.021) and frequent mitosis (urothelial carcinoma of the upper urinary tract, p = 0.003). DPP4 overexpression independently predicted poor DSS (urothelial carcinoma of the upper urinary tract, p = 0.028; urothelial carcinoma of the urinary bladder, p < 0.0001) and MeFS (urothelial carcinoma of the upper urinary tract, p = 0.031; urothelial carcinoma of the urinary bladder, p < 0.0001) in both groups of patients. Interpretation: Our study shows that overexpression of DPP4 is significantly associated with aggressive tumour behaviour and poor outcome. DPP4 may have an important role in tumorigenesis of urothelial carcinoma.
http://dx.doi.org/10.1016/j.ejca.2014.03.152 http://dx.doi.org/10.1016/j.ejca.2014.03.151
P0108 OVEREXPRESSION OF DPP4 IS A POOR PROGNOSTIC FACTOR FOR PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT AND URINARY BLADDER P-I. Liang a,*, W-J. Wu b,c,d, C-N. Huang b,c, C-C. Li b,c,e, H-L. Ke b,c, W-M. Li b,c, H-C. Yeh b,c,e, C-F. Li f,g,h, Y-Y. Lee f, H-H. Lin c, B-W. Yeh c, S-J. Hwang i . a Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, b Department of Urology, Faculty of Medicine, Kaohsiung Medical University, Taiwan, c Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, d Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, e Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan, f Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan, g National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan, h Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan, i Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan Background: Dipeptidyl peptidase-4 (DPP4), also known as CD26, is an enzyme that cleaves a diversity of protein that contains proline
P0109 DIETARY FACTORS INFLUENCING STOMACH CANCER INCIDENCE IN OMANI PATIENTS N.A.Y. Al-Saimi a, H.R. Chitme a,*, M. Al Mandhari b. a Department of Pharmacy, Oman Medical College, Bausher Campus, Muscat, Oman, b College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Background: Stomach cancer is one of the most common cancers in Oman. The age-standardised incidence of stomach cancer is higher in Oman than in all other GCC nations. In Oman, diet is traditional— high consumption of fish, red meat, and animal fats, especially from camel, and rather low consumption of raw fruits and vegetables. The main objective of this was to evaluate the possible dietary risk factors for stomach cancer in Omani patients. Methods: This small-scale hospital-based cohort and case–control study done by examining the records of patients with stomach cancer and prospectively by using questionnaires for stomach cancer patients and/or close relatives. The questionnaire was developed based on the literature on stomach cancer risk factors. Findings: Fifty-three patients with stomach cancer and 53 normal patients were included. Bread, beef, cheese, soft drinks, and sweet desserts had a significant adverse effect on the incidence and relative risk of stomach cancer (p < 0.05). However, consumption of fresh fruits,
e40
Abstracts / 50 (2014) e1–e74
vegetables, fruit juice, yogurt, tea, and vegetable salad significantly reduced the incidence and relative risk of stomach cancer (p < 0.05). Interpretation: There is a need to emphasise change of dietary beliefs and practices in all Omani families, with the strong focus on food habits, which may lower the risk of stomach cancer.
http://dx.doi.org/10.1016/j.ejca.2014.03.153
P0110 CHANGES IN QUALITY OF LIFE AND SYMPTOM EXPERIENCE IN BREAST CANCER PATIENTS WITH ADJUVANT TREATMENT J.H. Park a,*, Y.M. Jung a, S.H. Bae b. a Ajou University, South Korea, Dong-A University, South Korea
b
Background: Women diagnosed with breast cancer face significant side-effects such as nausea, vomiting, hair loss, and cognitive impairment and emotional distress due to aggressive adjuvant treatment. These side-effects adversely affect quality of life and symptom experience. The purpose of the study was to describe how quality of life and symptom experience develops over time in breast cancer patients undergoing adjuvant chemotherapy and radiotherapy. Methods: The study group was 113 women who had surgery and scheduled for adjuvant chemotherapy (n = 71) or radiotherapy (n = 42). Patients were assessed with quality of life (Functional Assessment of Cancer Therapy for Breast Cancer) and symptom experience (Memorial Symptom Assessment Scale-Short Form) before chemotherapy or radiotherapy (pretest), after chemotherapy or radiotherapy (post-test), and 6 months after chemotherapy or radiotherapy (followup test). Analysis of variance of repeated measures was used to investigate the change in quality of life and symptom experience in two groups. Findings: Patients receiving chemotherapy showed a significant increase in overall symptoms and physical symptoms between baseline and post-test. Overall quality of life, physical well-being, emotional well-being, and breast cancer specific domain decreased from pretest to post-test in the chemotherapy group but increased from post-test to the follow-up test. By contrast, there were no significant changes in symptom experience for the patients receiving radiotherapy. Significant increases were seen in overall quality of life, physical well-being, emotional well-being and breast cancer specific domain from baseline to follow-up test in patients receiving radiotherapy. Interpretation: When considering the substantial increase in life expectancy in persons with breast cancer, nursing practice and research should focus on quality of life and provide interventions to improve symptom experience and quality of life.
http://dx.doi.org/10.1016/j.ejca.2014.03.154
P0111 VOLTAGE-GATED K+ CHANNELS AS POTENTIAL THERAPEUTIC TARGETS FOR LUNG CANCER THERAPY S.H. Jang, S.Y. Choi, W.I. Jeon, P.D. Ryu, S.Y. Lee *. Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
Background: Voltage-gated K+ (kV) channels are considered to be a regulator of membrane potential and cell excitability. Recently, evidence has indicated that several kV channel subtypes contribute to the control of cell proliferation in various types of cancer cells and are worthy of investigation as molecular targets for cancer therapy. Methods: We investigated the effects of the dendrotoxin-j (DTX-j) and margatoxin (MgTX) which are Kv1.1 and Kv1.3 specific blockers, respectively, on tumour formation using a xenograft model induced by A549 and H460 cells. Findings: The mRNA and protein of Kv1.1 and Kv1.3 was expressed in A549 and H460 cells and the blockade of Kv1.1 by DTX-j or Kv1.3 by MgTX reduced the formation of tumours in nude mice. Furthermore, treatment with DTX-j significantly increased the protein expression of p21Waf1/Cip1, p27Kip1, and p15INK4B, and significantly decreased the protein expression of cyclin D3 in tumour tissues compared to control. In addition, selective inhibition of Kv1.3 significantly increased expression level of p21Waf1/Cip1 and significantly decreased the expression level of Cdk4 and cyclin D3. Moreover, we found that the effect of DTX-j and gefitinib was synergistic in H460 and A549 cells. Interpretation: These results suggest that certain kV channels may serve as novel therapeutic targets for lung cancer therapy and could be one of multiple molecular targets to overcome tyrosine kinase inhibitor resistance. This work is supported by National Research Foundation of Korea (2012R1A2A2A01047151).
http://dx.doi.org/10.1016/j.ejca.2014.03.155
P0112 ROLE OF NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED NASOPHARYNGEAL CARCINOMA M. Qasim Buriro *, R. Abdullah, H. Nisar . Pakistan Institute of Engineering and Applied Sciences Nilore, Islamabad, Pakistan Background: We evaluated the short-term efficacy and acute toxicities of neoadjuvant chemotherapy (cisplatin and fluorouracil) for locally advanced (stage II–IVB) nasopharyngeal carcinoma, from 1st November 2012 to 31st May 2013, at the Institute of Nuclear Medicine and Oncology Lahore (INMOL). International clinical studies of neoadjuvant chemotherapy in management of nasopharyngeal carcinoma (NPC) are still lacking. Methods: Fourteen patients with stage T3–4/N + M0 (stage II– IVB) nasopharyngeal carcinoma diagnosed histopathologically underwent baseline physical examination, appropriate laboratory tests, bone scan, and radiological imaging (chest X-ray, ultrasound of the abdomen, CT/MRI of the face and neck). The patients received two cycles of cisplatin 75 mg/m2 and fluorouracil 1000 mg/m2, day 1 and day 1 to day 5, every 3 weeks as neoadjuvant chemotherapy. Patients were assessed by appropriate laboratory tests on every 10th and 20th day of each cycle of chemotherapy. CT/MRI images were done after 3 weeks of completion of the second cycle of chemotherapy and were compared with baseline imaging for response evaluation. Findings: All patients completed two cycles of neoadjuvant chemotherapy. Major toxicities were non-haematological—vomiting and diarrhoea were seen in 50% of patients—and haematological—anaemia and leucopenia were seen in 43% patients. Ten (72%) of 14 patients showed a partial response in the primary tumour; the remaining four patients (28%) had stable disease. Seven (50%) patients had a complete nodal response; one patient who was N0 at baseline remained as N0 at follow-up, and one patient had stable nodal disease. Partial
Kerala, India, c Department of Biostatistics, Amrita Institute of Medical Sciences & Research Centre, Kochi, Kerala, India Background: Advances in radiotherapy techniques have improved clinical outcomes, but have also lead to concerns over subsequent acute and late effects. Dysphagia is one such complication that has garnered much attention. This retrospective study, conducted at a tertiary cancer care centre, aimed to analyse swallowing profiles of patients with cancer of anterior two-thirds of tongue, who had undergone surgery and had received adjuvant radiation using either IMRT or 3D CRT, as a surrogate of dose received by dysphagia aspiration-related structures (DARS). Methods: The treatment plans of patients treated using IMRT and 3D CRT, from November 2011 to December 2012, were retrieved from the planning system. The swallowing structures (DARS), namely superior, middle and inferior constrictors, base of tongue, larynx with supraglottis, and length of oesophagus, included in treatment volume with cricopharyngeous muscle, were contoured according to RTOG guidelines. Dose volume histograms were generated for these. Constraint doses were statistically derived. University of Washington Head-and-Neck-related Quality-of-Life questions addressing swallowing was used to evaluate swallowing status of patients. Findings: A statistically significant subjective correlation was found to exist between doses of swallowing structures, especially the constrictor muscles, base of tongue, and the larynx. Statistically derived probable mean dose-constraints correlated clinically with swallowing status of patients. IMRT had a statistically significant advantage over 3D CRT, in terms of V30 (p = 0.051), V50 (p = 0.002), V60 (p = 0.002), and D80 (p = 0.023) for the swallowing structures taken together. The probable limiting dose for dysphagia was 63 Gy for the superior constrictor and base of tongue, and 55 Gy for the larynx. Interpretation: Our study predicted possible mean dose constraints for the superior constrictor, base of tongue, and larynx. Further prospective studies are required to confirm these findings. Dysphagia-optimised IMRT is needed to improve swallowing status and quality of life in these patients.
e39
or analine, including chemokines, growth factors, and neuropeptide. Different DPP4 expression status has been observed in malignant tumours, including colon, renal, and ovarian carcinoma. Data mining of the published dataset (GSE31684) identified that DPP4 is significantly upregulated in urothelial carcinoma of the urinary bladder. We therefore analysed the association of DPP4 expression and outcome in our well-characterised cohort of urothelial carcinoma. Methods: Laser capture microdissection coupled with real-time qRT-PCR was used to evaluate DPP4 transcript level in 20 urothelial carcinomas of the urinary bladder. DPP4 immunostaining was done on 340 cases of urothelial carcinoma of the upper urinary tract and 295 cases of urothelial carcinoma of the urinary bladder. The expression status of DPP4 was then correlated with various clincopathological factors, disease-specific survival (DSS), and metastasis-free survival (MeFS). Findings: DPP4 mRNA expression was significantly increased in urothelial carcinomas with higher pT status (p < 0.001). In both groups of urothelial carcinomas, increment of DPP4 immunoexpression was significantly associated with advanced pT stage (both p < 0.001), high histological grade (urothelial carcinoma of the upper urinary tract, p = 0.019), lymph node metastasis (urothelial carcinoma of the upper urinary tract, p < 0.001; urothelial carcinoma of the urinary bladder, p = 0.033), vascular invasion (both p < 0.001), perineurial invasion (urothelial carcinoma of the urinary bladder, p = 0.021) and frequent mitosis (urothelial carcinoma of the upper urinary tract, p = 0.003). DPP4 overexpression independently predicted poor DSS (urothelial carcinoma of the upper urinary tract, p = 0.028; urothelial carcinoma of the urinary bladder, p < 0.0001) and MeFS (urothelial carcinoma of the upper urinary tract, p = 0.031; urothelial carcinoma of the urinary bladder, p < 0.0001) in both groups of patients. Interpretation: Our study shows that overexpression of DPP4 is significantly associated with aggressive tumour behaviour and poor outcome. DPP4 may have an important role in tumorigenesis of urothelial carcinoma.
http://dx.doi.org/10.1016/j.ejca.2014.03.152 http://dx.doi.org/10.1016/j.ejca.2014.03.151
P0108 OVEREXPRESSION OF DPP4 IS A POOR PROGNOSTIC FACTOR FOR PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT AND URINARY BLADDER P-I. Liang a,*, W-J. Wu b,c,d, C-N. Huang b,c, C-C. Li b,c,e, H-L. Ke b,c, W-M. Li b,c, H-C. Yeh b,c,e, C-F. Li f,g,h, Y-Y. Lee f, H-H. Lin c, B-W. Yeh c, S-J. Hwang i . a Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, b Department of Urology, Faculty of Medicine, Kaohsiung Medical University, Taiwan, c Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, d Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, e Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan, f Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan, g National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan, h Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan, i Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan Background: Dipeptidyl peptidase-4 (DPP4), also known as CD26, is an enzyme that cleaves a diversity of protein that contains proline
P0109 DIETARY FACTORS INFLUENCING STOMACH CANCER INCIDENCE IN OMANI PATIENTS N.A.Y. Al-Saimi a, H.R. Chitme a,*, M. Al Mandhari b. a Department of Pharmacy, Oman Medical College, Bausher Campus, Muscat, Oman, b College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Background: Stomach cancer is one of the most common cancers in Oman. The age-standardised incidence of stomach cancer is higher in Oman than in all other GCC nations. In Oman, diet is traditional— high consumption of fish, red meat, and animal fats, especially from camel, and rather low consumption of raw fruits and vegetables. The main objective of this was to evaluate the possible dietary risk factors for stomach cancer in Omani patients. Methods: This small-scale hospital-based cohort and case–control study done by examining the records of patients with stomach cancer and prospectively by using questionnaires for stomach cancer patients and/or close relatives. The questionnaire was developed based on the literature on stomach cancer risk factors. Findings: Fifty-three patients with stomach cancer and 53 normal patients were included. Bread, beef, cheese, soft drinks, and sweet desserts had a significant adverse effect on the incidence and relative risk of stomach cancer (p < 0.05). However, consumption of fresh fruits,
e40
Abstracts / 50 (2014) e1–e74
vegetables, fruit juice, yogurt, tea, and vegetable salad significantly reduced the incidence and relative risk of stomach cancer (p < 0.05). Interpretation: There is a need to emphasise change of dietary beliefs and practices in all Omani families, with the strong focus on food habits, which may lower the risk of stomach cancer.
http://dx.doi.org/10.1016/j.ejca.2014.03.153
P0110 CHANGES IN QUALITY OF LIFE AND SYMPTOM EXPERIENCE IN BREAST CANCER PATIENTS WITH ADJUVANT TREATMENT J.H. Park a,*, Y.M. Jung a, S.H. Bae b. a Ajou University, South Korea, Dong-A University, South Korea
b
Background: Women diagnosed with breast cancer face significant side-effects such as nausea, vomiting, hair loss, and cognitive impairment and emotional distress due to aggressive adjuvant treatment. These side-effects adversely affect quality of life and symptom experience. The purpose of the study was to describe how quality of life and symptom experience develops over time in breast cancer patients undergoing adjuvant chemotherapy and radiotherapy. Methods: The study group was 113 women who had surgery and scheduled for adjuvant chemotherapy (n = 71) or radiotherapy (n = 42). Patients were assessed with quality of life (Functional Assessment of Cancer Therapy for Breast Cancer) and symptom experience (Memorial Symptom Assessment Scale-Short Form) before chemotherapy or radiotherapy (pretest), after chemotherapy or radiotherapy (post-test), and 6 months after chemotherapy or radiotherapy (followup test). Analysis of variance of repeated measures was used to investigate the change in quality of life and symptom experience in two groups. Findings: Patients receiving chemotherapy showed a significant increase in overall symptoms and physical symptoms between baseline and post-test. Overall quality of life, physical well-being, emotional well-being, and breast cancer specific domain decreased from pretest to post-test in the chemotherapy group but increased from post-test to the follow-up test. By contrast, there were no significant changes in symptom experience for the patients receiving radiotherapy. Significant increases were seen in overall quality of life, physical well-being, emotional well-being and breast cancer specific domain from baseline to follow-up test in patients receiving radiotherapy. Interpretation: When considering the substantial increase in life expectancy in persons with breast cancer, nursing practice and research should focus on quality of life and provide interventions to improve symptom experience and quality of life.
http://dx.doi.org/10.1016/j.ejca.2014.03.154
P0111 VOLTAGE-GATED K+ CHANNELS AS POTENTIAL THERAPEUTIC TARGETS FOR LUNG CANCER THERAPY S.H. Jang, S.Y. Choi, W.I. Jeon, P.D. Ryu, S.Y. Lee *. Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
Background: Voltage-gated K+ (kV) channels are considered to be a regulator of membrane potential and cell excitability. Recently, evidence has indicated that several kV channel subtypes contribute to the control of cell proliferation in various types of cancer cells and are worthy of investigation as molecular targets for cancer therapy. Methods: We investigated the effects of the dendrotoxin-j (DTX-j) and margatoxin (MgTX) which are Kv1.1 and Kv1.3 specific blockers, respectively, on tumour formation using a xenograft model induced by A549 and H460 cells. Findings: The mRNA and protein of Kv1.1 and Kv1.3 was expressed in A549 and H460 cells and the blockade of Kv1.1 by DTX-j or Kv1.3 by MgTX reduced the formation of tumours in nude mice. Furthermore, treatment with DTX-j significantly increased the protein expression of p21Waf1/Cip1, p27Kip1, and p15INK4B, and significantly decreased the protein expression of cyclin D3 in tumour tissues compared to control. In addition, selective inhibition of Kv1.3 significantly increased expression level of p21Waf1/Cip1 and significantly decreased the expression level of Cdk4 and cyclin D3. Moreover, we found that the effect of DTX-j and gefitinib was synergistic in H460 and A549 cells. Interpretation: These results suggest that certain kV channels may serve as novel therapeutic targets for lung cancer therapy and could be one of multiple molecular targets to overcome tyrosine kinase inhibitor resistance. This work is supported by National Research Foundation of Korea (2012R1A2A2A01047151).
http://dx.doi.org/10.1016/j.ejca.2014.03.155
P0112 ROLE OF NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED NASOPHARYNGEAL CARCINOMA M. Qasim Buriro *, R. Abdullah, H. Nisar . Pakistan Institute of Engineering and Applied Sciences Nilore, Islamabad, Pakistan Background: We evaluated the short-term efficacy and acute toxicities of neoadjuvant chemotherapy (cisplatin and fluorouracil) for locally advanced (stage II–IVB) nasopharyngeal carcinoma, from 1st November 2012 to 31st May 2013, at the Institute of Nuclear Medicine and Oncology Lahore (INMOL). International clinical studies of neoadjuvant chemotherapy in management of nasopharyngeal carcinoma (NPC) are still lacking. Methods: Fourteen patients with stage T3–4/N + M0 (stage II– IVB) nasopharyngeal carcinoma diagnosed histopathologically underwent baseline physical examination, appropriate laboratory tests, bone scan, and radiological imaging (chest X-ray, ultrasound of the abdomen, CT/MRI of the face and neck). The patients received two cycles of cisplatin 75 mg/m2 and fluorouracil 1000 mg/m2, day 1 and day 1 to day 5, every 3 weeks as neoadjuvant chemotherapy. Patients were assessed by appropriate laboratory tests on every 10th and 20th day of each cycle of chemotherapy. CT/MRI images were done after 3 weeks of completion of the second cycle of chemotherapy and were compared with baseline imaging for response evaluation. Findings: All patients completed two cycles of neoadjuvant chemotherapy. Major toxicities were non-haematological—vomiting and diarrhoea were seen in 50% of patients—and haematological—anaemia and leucopenia were seen in 43% patients. Ten (72%) of 14 patients showed a partial response in the primary tumour; the remaining four patients (28%) had stable disease. Seven (50%) patients had a complete nodal response; one patient who was N0 at baseline remained as N0 at follow-up, and one patient had stable nodal disease. Partial