The Management and Present Treatment on Oropharyngeal Cancer


Nilesh S. Mhaske4, Abhishek R. Bura1, Amit N. Chavan2*, Dr. Devyani S. Bargal5,

Jyoti M. Hemanani3 and Sonal A. Allat2

1Dr. Vithalrao Vikhe Patil Foundation’s College of Pharmacy, Vilad Ghat, Ahmednagar, (MS), India, 414111

2Department of Pharmaceutics, Dr. Vithalrao Vikhe Patil Foundation’s College of  Pharmacy, Vilad Ghat, Ahmednagar, (MS), India, 414111

3Department of Pharmacology, Dr. Vithalrao Vikhe Patil Foundation’s College of Pharmacy, Vilad Ghat, Ahmednagar, (MS), India, 414111

4Asst. Prof.  Department of  Pharmaceutics, Padmashri Dr. Vithalrao Vikhe Patil Foundation’s College of Pharmacy, Vilad Ghat, Ahmednagar, (MS), India, 414111

5Yashwant Rao Chavan Dental College Ahmednagar.

*Corresponding Author E-mail:



All over the world there are 65000 patients diagnosed with this cancer and 350,000 die also. India has the highest no of oral cancer. Every year it’s grown by 30% with new cases rage stain to the drug annually. The aim of this article is: to give short review oropharyngeal anatomy. To evaluate the literature on the human papilloma virus association with oropharyngeal cancer; to evaluate the current literature on evolving diagnostic methods for oropharyngeal cancer; and give strategy for management of oropharyngeal cancer.


KEYWORDS: Oropharyngeal cancer, Papilloma, Lipoma, Schwannoma, Fibroma.




There are 100 types of the cancer. Oral cancer is the 11 most universal cancers worldwide1-3. In the worldwide 650, 00 patients diagnosed with this type of cancer. Each year 350,000 die from this cancer. The main causative of the 85% of laryngeal carcinomas, oral and oropharyngeal is smoking and alcohol. Squamous 90% cell are carcinoma. 15% from reaming die because of the other factor.


From the worldwide two-thirds patients are developing from the Asia, Eastern Europe and Latin America4. In Asia India is the country which has the most cancer patients. In men it’s has heights cancer type, then the women in the ratio with 2:1 and 30% of all new cases per year.5-7 As per the death ratio in India 30% of men’s are die because of the cancer. Because of poor treatment facility there are almost 60% patients are at the stage of III and IV of cancer.8 as time pass no of patients will be increasing. The patients between age of 55- 65 are having the high oral cancer patients. In India, Pakistan and Sri Lanka there are patients below the age of <409. Amount is get increasing as the days are passing on. 


In Canada there are incidences rates are largely described among the head and neck subsets. That’s why its difficult to assess the impact of oropharyngeal cancer on the population health in the country. In the oral cavity to the posterior side pharynx is located, It contain the oropharynx In between the nasopharynx and the hypopharynx. On the subsets of the base of tongue, tonsillar region, soft palate and pharyngeal wall there is oropharynx is located. In oropharyngeal cancers 90% or more Squamous cells are carcinomas10. The oropharyngeal cancers in patients are often indicated until the tumor reaches at its significant size at lymph node in the neck. 70% in patients in the Canada are at advanced staged (stage III and IV)11. In the increasing the oropharyngeal cancer Human papillomavirus (HPV) is also well-recognized major risk factor. 90-95% of HPV- positive cancer mostly happened by HPV1612. There are varies treatment options are available as radiation, surgery and chemotherapy. The treatment can be offered as single modality or combined modality as per the stage, subset and patient performance statues against the tumor cell or cancer cells.





Figure no.: 1.1 Composition of soft palate, Uvula, Palatine tonsils and Oropharynx.



Abnormal growths of cell are called as the tumors and can be developed in the oral cavity.

There are 3 types of general categories in tumor.

1.      Benign or its also called as NCG (non-cancerous growths) they did not spread in to the body and also other tissue of the body is not affected.

2.      Harmless category which growth is fast and they can further developed in to the cancer.

3.      Cancerous tumor its can spread fast and also can affect the other body tissue and parts.


Benign or NCG tumors15:

In the mouth and throat at benign tumors like condition can start. There are many type of it as follow:

1.      Verruciform xanthoma

2.      Eosinophilic granuloma

3.      Papilloma

4.      Granular cell tumor

5.      Keratoacanthoma

6.      Osteochondroma

7.      Schwannoma

8.      Odontogenic tumors(tumors that start in tooth-forming tissues

9.      Fibroma

10.   Condyloma acuminatum

11.   Leiomyoma

12.   Pyogenic granuloma

13.   Rhabdomyoma

14.   Lipoma

15.   Neurofibroma)


These cell are not treated of cure but are removed by surgery completely before and after words sine it come back.



A risk factor cans changes as person to person and its type of cancer. As the type changes the risk factor get changed. Smoking is the one of the risk factor for many cancers. The different risk factor such as the age, diet, drinking, smoking and other. Having a risk factor or many more can’t say that person will affected with that disease. Following are the type of risk factor:


1.      Tobacco and alcohol

2.      Drinking alcohol

3.      Drinking and smoking together

4.      Human papilloma virus (HPV) infection (There are more than 150 types of viruses)

5.      Gender

6.      Age

7.      Ultraviolet (UV) light

8.      Poor nutrition

9.      Graft-versus-host disease (condition which occurs sometime after a stem cell

10.   Transplant)

11.   Weakened immune system

12.   Genetic syndromes (Fanconi anemia and Dyskeratosis congenital)

13.   Irritation from dentures



Scientists cant say tell today about causes of each case of oral cavity or orophartngeal cancer. But they know many of the risk factor which are given above. Scientists say that from that risk factor tobacco and the heavy alcohol drinking may lead changes in to the DNA damaging.



Avoid all the risk factor which are given above can lower the chance of cancer. Oral cavity and oropharyngeal cancer cant prevented by avoiding the risk factor but can lower the risk.

1.    Limit smoking and drinking:

In the cancer Tobacco and alcohol are the major factor for the cancer. Lowering the risk of the cancer can be done by preventing the smoking and drinking. Tobacco and alcohol can damage the DNA in large amount in the all part of the body.


2.    Avoid human papilloma virus (HPV) infection:

The human papilloma virus or HPV infection can be spread or can affect because of the oral sex and multiple sex partners. This infection is also common in the highly smoking person. It damages the immune system of the body of the person or the cells which are in the oral cavity.


3.    Limit exposure to ultraviolet (UV) light:

UV radiation is one of the causes of happening the cancer and also the skin cancer.

When ever you come out at time when the sun light contains the huge amount of radiations at that time you should where the sun cote and hat. To avoided or lower the radiation affect on the skin and other body part.


4.    Wear properly fitted dentures:

Not properly fitted dentures can cause the irritation which can cause the cancer. Avoid such type of the dentures.



There are several symptoms of oral cavity cancer can be seen, as follow:

·        The mouth sore that does not heal (most common symptom)

·        Pain in the mouth that doesn’t give relief (also very common)

·        A cheeks thickening is happened.

·        A white or red patch on the gums, tongue, tonsil, or lining of the mouth

·        A pain throat or a feeling that something is caught in the throat that doesn’t go away

·        Swallowing and chewing trouble occurs.

·        The jaw or tongue starts troubling in the movement.

·        Numbness of the tongue or additional region of the mouth

·        Dentures fit poor or become uncomfortable because of swelling of jaw.

·        Loosening of the teeth or pain around the teeth or jaw

·        Changes in the voice have been seen.

·        A mass in the neck occurs.

·        Weight loss

·        Constant bad breath






1.    Medical history and physical exam:

The patient physical exam is done for the diagnosed the cancer and also checks the medical history.


2.    Head and neck exam:

The complete head and neck examination is done for the diagnosed the cancer. Whiter there is any unwanted think is present in the nick.


3.    Panendoscopy:

Laryng, Escophago and broncho this type of endoscopes are performed or passed down to the mouth or nose by the doctor in the panendoscopy. The oral cavity or opharynx, larynx (voice box), throat (tube leading to the stomach) and trachea (windpipe) and bronchi (breathing passageways in the lungs) this type of parts are exam by doctor. The general anesthesia is giving to the patient while this test.


4.    Exfoliative cytology:

IN this the doctor take scrape the area or smears where the tissue are suspicious and take it on the glass slide. The different kind of dyes is apply to mark the sample and then observed under the microscope. The area is biopsied if the cell in the obsevae looks abnormal. In this technique the abnormal looking areas can be examined and it’s easy and less time consuming technique.  


5.    Incisional biopsy:

In this technique the doctor take out small cut piece form the area which looks abnormal. The test is done in the doctor lab or in the operation room, its depending up on the tissue sample quality. This test is commonly done in the investigating the cancer in the oral cavity and throat.


6.    Fine needle aspiration (FNA) biopsy:

In this technique the hollow needle is attach to the syringe to take out the some cell sample for testing. Then the cell are observed under the microscop for the cancer cell present or not. 


7.    Chest x-ray:

In the X ray we can see that the cancer is spread all over the body or not. It can see the amount of the cancer cell are spread in the body.



a.    CT (Computed tomography)

b.    MRI (Magnetic resonance imaging)

c.    PET (Positron emission tomography)

d.    Blood tests





There are three types of stage of the cancer

As follow:

1.     T (tumor size is indicates by this)

2.     N (lymph node nearby it is spread)

3.     M (it tells about spread of the cancer cell in the other body part (metastasis))


1.      T (tumor):

a.    Tx: In this evaluation of primary site is not possible.  cannot be evaluated

b.    T0: Carcinoma evidence is not found.

c.    Tis: On site carcinoma is found.

d.    T1: tumor cell is < 2cm in greatest in the dimension.

e.    T2: tumor cell is 2-4cm in greatest in the dimension.

f.     T3: tumor cell is > 4cm in greatest in the dimension.

g.    T4 : contains two sub types:

·      T4a: invades larynx, deep/extrinsic tongue muscles, medial pterygoid, mandible

·      T4b: attack on the side pterygoid, pterygoid plates, lateral nasopharynx, skull base, or carotid


2.      N (lymph node):

a.      Nx: Evaluation of lymph nodes are not possible

b.      N0: It not spread near to it.

c.      N1: As primary tumor it has been spread at the one side of the neck and head area.

d.      N2 : It cares 3 subgroups


N2a: single node involved (3-6cm)

N2b: numerous nodes occupied unilaterally (less than 6cm)

N2c: bilateral nodal involvement (less than 6cm)

N3: nodal involvement (greater than 6cm)



Chemotherapy for oral cavity and oropharyngeal cancer:

The treating the cancer in the body the chemotherapy is the best treatment. The drugs of the chemotherapy are given by the mouth or by injecting in the veins and then the drug goes into the bloodstream and reaches to cancer site and shows the actions. There are different types of situations in the chemotherapy as follow:



Figure no.; 1.2 Treatment Of chemotherapy for oral cavity and oropharyngeal cancer.




Figure No.:1.3 Drugs used in oral and oropharynx cancer.




Figure No.:1.4 Other drugs for treatment of Oropharyngeal Cancers..




Chemo drugs harass cells that are separating quickly, which is why they work against cancer cells. But other cells are lining in the body, such as in the bone marrow, of the mouth and intestines, and the hair follicles are affected. Side effects can be occurring.


The side effects of chemo depend on the type of chemotherapy and drugs dose. How long patient have taken. These side effects include:

·      Hair loss

·      Mouth sores

·      Loss of appetite

·      Nausea and vomiting

·      LBC (Low blood counts)

·      Chemotherapy can affect the blood-producing cells of the bone marrow and it is going to lead in low blood cell counts.26

·      This can lead to:

·      Due to decrees in WBC counts the risk on increasing infection occurs.

·      Easy bruising or bleeding (due to low blood platelet counts)

·      Because of low RBC counts the fatigue occurs.

·      Along with the risks above, some side effects are seen




The different types of the health problems can be affected to the cancer patients but it will be more critical to facing cancer again. It is also possible that some cancer can be back after some time. This is called as the second cancer. No matter what type of the cancer you has but the other type of cancer can be happened to you is possible. The other cancer can also be affect to the patient while treating the privies one. Patients who have the first cancer of Oropharyngeal can be affected or can be happened the second other type of the cancer. Types of the cancer as given follow:




Figure No.:1.5     Types of cancers can be affected.



Figure No.:1.6 increased risk of  oral cancer as secondary cancer.




Today’s research is going more advances against the cancer. Many universities and other institution around the globe are doing a research to destroy the cancer from its roots.  Each year the scientist is developing the new technology to prevent it and to cure it   and improve the treatment. 


Following are the new advance technology which is developed by the scientist around the world for the treatment of cancer.


1.      DNA changes ( Mutation of the TP53 gene of the DNA in oral cancer)

2.      Prevention

a.      Chemoprevention

3.      Treatment

a.      HPV related cancers

4.      Surgery

5.      New chemotherapy approaches

6.      New radiotherapy methods

a.      Stereotactic radiosurgery/stereotactic radiotherapy:

b.      Proton beam therapy

7.      Targeted therapy

8.      Vaccines

9.      Gene therapy






Name of Drug

Pharmaceutical Forms and Strengths


(Category 2B)

10mg IV bolus twice weekly on Tuesday and Thursday

Followed by

Radiotherapy 25Gy split into two courses. Each course given in  10 fractions over 2 weeks, with a 2 weeks split


15mg IM twice a week.


25mg/m2 daily followed by radiotherapy 5 daily fraction of 1.8 or 2 Gy.


1250mg/m2 PO

Followed by a 1-week rest period. Repeat every 3 weeks for at least two cycles.


IV: 75-100mg/m2/day


400mg/m 2 over 2 hours as a loading dose

Followed by

250mg/m2 IV over 1 hour weekly. Repeat at least every 6 weeks.


100 mg/m 2 IV over 15-20 minutes. Repeat every 3-4 weeks.


1 mg , 200 mg and 500 mg.


40 to 100 mg/m2 IV over 1 hour. Repeat every 3 weeks.


2mg and 50 mg.




(Category 2B)

3g/m2 IV daily plus mesna 600mg/m2 PO daily. Repeat every 3 weeks.


1000mg/m2over 24 hours. Repeat every 3 weeks.


40mg/m2 IV weekly.


8mg/m2 IV over 1 hour. Repeat every 6 weeks.


 30mg/m2/weeks IV.



lyophilized powder, 10,000 IU

vial (IV)


500 mg capsule

100 mg and 400 mg tablet sodium iodide.

10 mg/mL, 10 mL and 50 mL vial (IV),

150 mg lyophilized powder (IV)


20 to 40 mg daily (Tablet)


Table 2:- Chemotherapy Regimens33-34.

Primary Systemic Therapy + Concurrent Radiotherapy


Day 1, 22 and 43:

cisplatin 100mg/m 2 IV on


Concurrent radiotherapy 2 Gy/day to a total of 70 Gy.



400mg/m 2 IV dose for 1 wk before stating of radiation therapy.

Day 7:

Then 250mg/m 2 Wk


Carboplatin  + Infusional 5-FU

Day 1-4:

5-FU 600mg/m/ days as continuous in infusion


Carboplatin 70 mg/m2 day IV.

5-FU + Hydroxyurea

Day 1:

Hydroxyurea 1000 mg PO every 12 hours and 5-FU 400 mg/m2/day continuous IV infusion


Radiotherapy: 70 Gy, delivered in 35 fractions.

Cisplatin + Paclitaxel



Day 1:

Paclitaxel 30mg/m2 IV


Cisplatin 20mg/m2(every Tuesday). Repeat cycle for 7 WK.


Radiotherapy: 70 Gy, delivered in 35 fractions. Delivered daily Monday – Friday.

Cisplatin + Infusional 5-FU


Day 1:

Cisplatin 60mg/m2 over 15 min.


5-FU 800mg/m2 by continuous infusion.


Radiotherapy 2 GY repeated every other week for 7 cycles.


/ Paclitaxel (Category 2B)

Dayt 1:

40-45 mg/m2 week and carboplatin 100 mg/m2/ week prior to radiotherapy 70.2 GY at 1.8Gy/fraction/day for 5 days/week.

Weekly cisplatin

(category 2B)


Cisplatin 40mg/mg2 IVC over 30 min. weekly; plus

Day 1-38:

Radiotherapy 1.8Gy single dose (up to dose of 50.4Gy) plus

Day 22-38:

Boost radiotherapy 1.5Gy/day(up to 19.5Gy)in addition to regular dose. Give at least 6 hours after regular dose. Or day

Day 1-28:

Cisplatin 40mgmg2 IV weekly

Day 1-40:

Radiotherapy 5 fraction of 1.8 GY/week up to 54Gy. Plus

Day 25-40:

Boost radiotherapy 1.5Gy to 19.5Gy in additional to regular dose.

Primary Chemotherapy with Postoperative Chemoradiation


( Category 1 for high risk)

Days1,22 and 43:

100mg/m2 IV + radiotherapy.

Induction Chemotherapy/ Sequential chemotherapy.

Docetaxel  + Cisplatin + 5-FU



Docetaxel 75mg/m2 + cisplatin 75mg/m2 IV



750mg/m2 continues IV

Paclitaxel  + Cisplatin + Infusional 5-FU

Day 1:

Paclitaxel 175mg/m2 over 3 hours

Day 2:

Cisplatin 100mg/m2



5-FU 500mg/m2continus infusion repeat every 3 weeks for 3 cycles.

Nasopharynx Cancer

Cisplatin + Radiotherapy + Cisplatin  +



Cycles 1-3:


Cisplatin 100mg/m2IV


Radiotherapy repeat  cycle every 3 weeks;

Followed by

Cycle 4-6

Days 1-4:

Cisplatin 80mg/m2/day + 5- FU 1000mg/m2/ day IV over 96 hours.

Carboplatin + Radiotherapy + Carboplatin + 5-FU

(Category 2B)


Cycles 1-3


Carboplatin AUC 6 IV ;



200cGy/fraction w/ Five daily fraction / week, repat every 3 weeks for 3 cycles

Followed by

Cycles 4-6

Days 1-4:

Carboplatin AUC 5 IV +5—FU 100mg/m2/day IV over 96 hours.



Word has suffering from more amount of oral and oropharyngeal cancer patient’s. Oral and oropharyngeal cancer at present early detection test are not available because of insufficient data. Some studies show that different part of world has different tumor biology. In high risk patient’s surgery remain treatment of choice. 



1.       American Cancer Society. Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society; 2016.

2.       American Joint Committee on Cancer. Lip and Oral Cavity. In: AJCC Cancer Staging Manual, 7th ed. New York, Springer: 2010; 29–35.

3.       Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010.

4.       American Joint Committee on Cancer. Pharynx. In: AJCC Cancer Staging Manual, 7th ed. New York, Springer: 2010; 41–49.

5.       Choi WH, Hu KS, Culliney B, Sessions RB, Harrison LB. Cancer of the oropharynx. In: Harrison LB, Sessions R.B. H, W.K., editors. Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Philadelphia, PA: Lippincott, William and Wilkins; 2009.p. 285.

6.       Henley SJ, Thun MJ, Connell C, Calle EE. Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States). Cancer Causes Control. 2005; 16:347–358.

7.       Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975- 2011, National Cancer Institute. Bethesda, MD,, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

8.       Cogliano V, Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F. Smokeless tobacco and tobacco-related nitrosamines. Lancet Oncol. 2004; 5:708.

9.       Curado MP, Edwards B, Shin HR, Ferlay J, Heanue M, et al. (eds). Cancer incidence in five continents: Vol. 9, IARC Scientific Publication No. 160. Lyon, France: International Agency for Research on Cancer, 2009.

10.     Bsoui SA, Huber MA, Terezhalmy GT. Squamous cell carcinoma of the oral tissues: A comprehensive review for oral healthcare providers. J Contemp Dent Pract. 2005; 4:1–16.

11.     Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011 Nov 10; 29(32):4294-4301.

12.     Odell MJ, Walz BJ, Reimers H-, Varvares MA. Carcinoma of the Oropharynx. In: Genden EM, Varvares MA, editors. Head and Neck Cancer. An Evidence-Based Team Appraoch. New York, NY: Thieme Medical Publishers, Inc; 2008. p. 24.

13.     Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010; 363:24–35.

14.     Atkinson JC, Harvey KE, Domingo DL, et al. Oral and dental phenotype of dyskeratosis congenita. Oral Dis. 2008; 14:419–427.

15.     Koch WM, Stafford E, Bajaj G. Cancer of the Oral Cavity. Part A: General Principles and Management. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck Cancer:A Multidisciplinary Approach. Philadelphia, Pa: Lippincott Williams and Wilkins; 2009:250–265.

16.     Gillison ML, Broutian T, Pickard RK, Tong ZY, Xiao W, Kahle L, Graubard BI, Chaturvedi AK. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012; 307(7):693-703. Epub 2012 Jan 26.

17.     Liu SZ, Zandberg DP, Schumaker LM, Papadimitriou JC, Cullen KJ. Correlation of p16 expression and HPV type with survival in oropharyngeal squamous cell cancer. Oral Oncol 2015.

18.     Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005; 365:1927–33.

19.     Kutler DI, Auerbach AD, Satagopan J, et al. High incidence of head and neck Squamous cell carcinoma in patients with Fanconi anemia. Arch Otolaryngol Head Neck Surg.2003; 129:106–112.

20.     Menedenhall WM, Werning JW, Pfister DG. Treatment of head and neck cancer. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2011:729–780.]

21.     D’Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007; 356:1944–1956.

22.     Herrero R, Castellsagué X, Pawlita M, et al. Human papillomavirus and oral cancer: the International Agency for Research on Cancer multicenter study. J Natl Cancer Inst. 2003; 95(23):1772-1783.

23.     Lingen MW, Kalmar JR, Karrison T, Speight PM. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 2008; 44:10–22(1)

24.     National Cancer Institute. Physician Data Query (PDQ). Lip and Oral Cavity Cancer Treatment. 2/28/2014. Accessed at on June 5, 2014.

25.     National Cancer Institute. Physician Data Query (PDQ). Oropharyngeal Cancer Treatment. 12/12/2013. Health Professional on June 5, 2014.

26.     National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Head and Neck Cancers. 2015; Available at: Accessed 07/30,2015 (2)

27.     Paleri V, Rees G, Arullendran P, et al. Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis. Head Neck. 2005; 27:739– 747.

28.     Wrangle JM. Khuri FR. Chemoprevention of squamous cell carcinoma of the head and neck. Current Opinion in Oncology. 2007; 19:180–187.

29.     National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V.2.2014. Accessed at on June 5,2014.

30.     Vartanian JG, Magrin J, Kowalski LP. Total glossectomy in the organ preservation era.Curr Opin Otolaryngol Head Neck Surg. 2010; 18:95–100.

31.     Quon H. Cancer of the head and neck. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE. Kastan MB, McKenna WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa. Elsevier; 2008: 1177–1228.

32.     Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359:1116–1127.

33.     Piccirillo JF, Costas I, Riechmann ME. Cancers of the Head and Neck. In: Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988–2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.





Received on 24.01.2018                Modified on 06.04.2018

Accepted on 19.05.2018            © A&V Publications All right reserved

Asian J. Res. Pharm. Sci. 2018; 8(2):91-99.

DOI: 10.5958/2231-5659.2018.00017.6