title: Neoadjuvant and concomitant chemotherapy and radiation therapy in patients with advanced head and neck carcinoma.
abstract: Our study evaluated the effectiveness of neoadjuvant chemotherapy and concomitant chemotherapy with radiotherapy compared to standard surgery and radiation therapy in patients with resectable stage III/IV head and neck squamous cell carcinoma. Forty-two eligible patients received neoadjuvant chemotherapy (cisplatin 100 mg/m2 intravenously day 1, and 5-fluorouracil 1 g/m2 /day continuous infusion days 1-5 every 3 weeks for 3 courses) followed by radiotherapy (65-70 Gy in 32-39 fractions to the primary site and lymph nodes; 50 Gy in 25-28 fractions to areas at risk) and concomitant chemotherapy (cisplatin 80 mg/m 2 intravenously every 3 weeks starting on day 1 of radiotherapy). Neoadjuvant therapy induced grade 4 cytopenias (12/42 patients) and grade 4 gastrointestinal toxicities (7/42 patients). Concomitant radiochemotherapy-induced grade 4 toxicities (6 patients). Neoadjuvant chemotherapy biopsy-proven complete responses were 15 of 42 patients (36%), partial responses in 23 of 42 patients (55%), and an overall response rate of 91%. Thirty-seven of 38 responders received concomitant radiochemotherapy. Complete responses in 35 of 42 patients (83%), partial response in 7 of 42 patients (7%), and overall response in 90%. The 3-year disease-free and overall survival for chemotherapy plus radiotherapy versus surgery plus radiotherapy: 61% versus 43% (P = 0.17) and 71% versus 43% (P = 0.02). These data suggest that a randomized trial of concomitant radiochemotherapy versus neoadjuvant plus concomitant radiochemotherapy should be considered.
  
  
  METHODS
  B-2.
authors.affiliation: University of Alabama at Birmingham, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rinehart
authors.forename: Tibor
authors.initials: T
authors.lastname: Ruff
authors.forename: Alan
authors.initials: A
authors.lastname: Cheung
authors.forename: Lewis
authors.initials: L
authors.lastname: Hutchinson
authors.forename: Roger
authors.initials: R
authors.lastname: Tuggle
authors.forename: D Randall
authors.initials: DR
authors.lastname: Pinkston
authors.forename: Lisa
authors.initials: L
authors.lastname: Keville
authors.forename: Lucas
authors.initials: L
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate