title: Primary site management following induction chemotherapy with cis-platinum, 5-fluorouracil, and leucovorin.
abstract: A phase II clinical trial was initiated in 1987 to evaluate a new induction regimen of cis-platinum, 5-fluorouracil, and leucovorin (PFL) for patients with stages III-IV squamous cell carcinoma of the head and neck. Ninety patients were treated and followed for a median duration of 18 months. The median age was 55 and 87% of the patients had stage IV disease. The rates of complete and overall clinical response following three cycles of PFL were 57% and 80%, respectively; the rate of complete response at the primary site was 72%. Eighty-four percent of patients were treated to the primary site with radiation alone (median dose 68 Gy in daily 1.8-Gy fractions) irrespective of the location of the primary site or initial T-stage. The acute tolerance to full-course radiation following PFL was acceptable. The actuarial rate of primary site control for patients treated with radiation was 67% at 36 months. An important prognostic indicator for primary site control was a complete clinical response to induction PFL. For patients who achieved a complete response, radiation or surgery followed by radiation controlled primary site disease equally well at 70%. Patients with a partial response did less well. For these patients, surgery and radiation appeared slightly better than radiation alone.
authors.affiliation: Head and Neck Tumor Service, Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: P M
authors.initials: PM
authors.lastname: Busse
authors.forename: J R
authors.initials: JR
authors.lastname: Clark
authors.forename: C J
authors.initials: CJ
authors.lastname: Beard
authors.forename: A I
authors.initials: AI
authors.lastname: Dreyfuss
authors.forename: J W
authors.initials: JW
authors.lastname: Lucarini
authors.forename: R
authors.initials: R
authors.lastname: Rossi
authors.forename: D
authors.initials: D
authors.lastname: Casey
authors.forename: C M
authors.initials: CM
authors.lastname: Norris
mesh_terms: D000206:Actuarial Analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage*; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil