title: Retrospective analysis of surgical resection after induction chemotherapy for patients with T4b squamous cell head and neck cancer.
abstract: BACKGROUND
  Standard treatment of patients with T4b squamous cell head and neck cancer (T4b-SCHNC) is concomitant chemo-radiotherapy (CT-RT). Recent Phase III trials with Taxane containing induction chemotherapy (IC) suggest that IC could also play a role in this setting. The value of resecting the residual mass after IC and before RT is not yet clear in this context.
  
  
  METHODS
  We present the results of a retrospective analysis.
  
  
  RESULTS
  Between 1984 and 2001, 113 patients (patients) with T4b-SCHNC were treated at our institution with IC. Four patients dead during IC and 57 patients achieved a complete or a >90% partial response at primary and proceeded to definitive RT (or concomitant CT/RT). Surgical resection was reconsidered after IC and before RT in the other 52 patients. Surgery was performed in 13 of them: in 7 patients resection was R1, all of them had loco-regional progression (2 also developed systemic metastases) and median OS after surgery was 21 months, with no patient alive at 48 months. In the other 6 patients a R0 resection was performed: 3 of these patients had loco-regional relapses (1 also developed systemic metastases) and the other 3 patients remain alive and disease free 56, 62 and 72 months after surgery. Considering the 52 patients that achieved less than a 90% partial response at primary with IC, overall survival was equivalent when no Resection or an R1 resection was performed after IC (5 year OS 8 vs. 0%, lrk, p=0.74), but a statistically significant improvement in OS was observed when an R0 resection was obtained (5 years OS 50%, lrk, p=0.02).
  
  
  CONCLUSIONS
  R0 resections after IC and before RT could indicate an improvement in OS in patients with T4b-SCHNC that obtain less than a 90% PR at primary after IC. We consider that this approach deserves further research in prospective clinical trials.
authors.affiliation: Department of Medical Oncology, University Hospital Marqués de Valdecilla, Santander, Spain. oncrhf@humv.es
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivera
authors.forename: María
authors.initials: M
authors.lastname: Eugenia Vega-Villegas
authors.forename: Carlos
authors.initials: C
authors.lastname: López
authors.forename: María
authors.initials: M
authors.lastname: Francisca López-Brea
authors.forename: Antonio
authors.initials: A
authors.lastname: Rubio
authors.forename: Adolfo
authors.initials: A
authors.lastname: Del Valle
authors.forename: Fe
authors.initials: F
authors.lastname: García-Reija
authors.forename: Belen
authors.initials: B
authors.lastname: García-Montesinos
authors.forename: Julio
authors.initials: J
authors.lastname: Rodríguez-Iglesias
authors.forename: Carmen
authors.initials: C
authors.lastname: Hinojo
authors.forename: Raul
authors.initials: R
authors.lastname: Márquez
authors.forename: Miguel
authors.initials: M
authors.lastname: Angel Alonso-Bermejo
authors.forename: Matilde
authors.initials: M
authors.lastname: Salcedo
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Blanco
authors.forename: Noelia
authors.initials: N
authors.lastname: Vega
authors.forename: Sara
authors.initials: S
authors.lastname: López-Tarruella
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz-Ortiz
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014498:Uracil / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D014498:Uracil; D014747:Vinblastine; D016190:Carboplatin; D002945:Cisplatin; D000077235:Vinorelbine; D007069:Ifosfamide