Hypercalcemia in head and neck squamous-cell carcinoma

Hypercalcemia was previously considered a terminal phenomenon in advanced head and neck squamous-cell carcinoma. We report on six patients with head and neck carcinoma and hypercalcemia refractory to conventional measures. Three patients had stage IV tumor not amenable to surgery or radiation therapy and three others had carcinoma recurrent after surgery and/or radiation therapy. Five of the six patients had paraneoplastic hypercalcemia and one had extensive bone metastases. One refused chemotherapy and died in 2 months. Five treated with cisplatin 100 mg/m2 i.v. and 5-fluorouracil (5-FU) 960 mg/m2/day x 5, on days 2-7 as a continuous infusion, had prolonged control of hypercalcemia and required no other therapy to maintain eucalcemia. All three patients with no prior therapy, and one of the two patients with recurrent cancer, had a partial response after chemotherapy. The survivals of the patients with recurrent cancer were 1 and 3 months. The survivals in the patients with no prior antitumor therapy were 10, 11+, and 23 months, respectively. In conclusion, hypercalcemia in head and neck carcinoma can be well controlled by cisplatin and 5-FU chemotherapy for a prolonged period. The impact of chemotherapy on survival was minimal in patients with recurrent cancer. In contrast, patients with hypercalcemia at initial presentation of an advanced head and neck cancer have a high likelihood of tumor control and prolongation of survival by chemotherapy.