Carcinoma of the head and neck: a 5- to 20-year experience with preoperative chemotherapy, uncompromised surgery, and selective radiotherapy.
BACKGROUND
A 5- to 20-year evaluation of preoperative chemotherapy uncompromised surgery and selective radiotherapy in stage III/IV head and neck squamous cell carcinoma.


METHODS
Eighty-two consecutive patients, single surgeon previously untreated, operable, and resectable for cure. Sites included the oral cavity, oropharynx, larynx, and hypopharynx. Two chemotherapeutic regimens were used: initial regimen (A), cisplatin/bleomycin (n = 45 patients); revised regimen (B), cisplatin/5-fluorouracil (n = 37 patients). The extent of surgery was carefully documented before chemotherapy-tattoo when feasible. This forms a strict guide for uncompromised surgery. Selective postoperative radiotherapy was based on specific criteria.


RESULTS
Minimum follow-up was 5 years. Absolute survival: total group, 60%; regimen A, 46%; and regimen B, 77% (P =.004). Relative survival (correcting for life table mortality): total group, 66%; regimen A, 50%; and regimen B, 83% (P =.003). Recurrences: primary site, n = 9 (regimen A, n = 7 [16%]; regimen B, n =2 [5%]) and neck, n = 6 (13%, all in regimen A). Distant metastasis occurred in 12 patients (10 [22%] in regimen A and 2 [5%] in regimen B).


CONCLUSIONS
This study suggests treatment of advanced head and neck squamous cell carcinoma (resectable for cure) with preoperative chemotherapy (regimen B); resection of original tumor volume, regardless of response to chemotherapy; and selective (rather than routine) postoperative radiotherapy results in improved survival. More controlled studies are recommended.
Loré
John M
JM
Head and Neck Center, Sisters of Charity Hospital, Buffalo, New York, USA.
Kaufman
Sol
S
Sundquist
Nan
N
Chary
Kandala K
KK
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome
D001761:Bleomycin; D002945:Cisplatin; D005472:Fluorouracil