title: Selective organ preservation in operable locally advanced head and neck squamous cell carcinomas guided by primary site restaging biopsy: long-term results of two sequential brown university oncology group chemoradiotherapy studies.
abstract: OBJECTIVE
  The long-term outcomes of selective organ preservation in operable, locally advanced head and neck cancers in two sequential chemoradiotherapy (CRT) protocols (HN-53, HN-67) are reported.
  
  
  METHODS
  A total of 65 patients were treated with CRT consisting of carboplatin (AUC=1/week) and paclitaxel (60 or 40 mg/m2/week) with radiation (1.8 Gy/day). After 5 weeks of CRT, if primary site biopsies were pathologically negative, then completion CRT to 67-72 Gy was done with neck dissection in node-positive cases. Alternatively, a positive rebiopsy required primary site resection and neck dissection followed by radiotherapy boost as deemed necessary.
  
  
  RESULTS
  Pathologic complete responses occurred in 71% patients who then completed CRT; the remaining 29% patients underwent primary site surgery. The 5-year and median overall survival were 47% and 57 months with no statistically significant differences between the two groups. Overall long-term failure rates were: 6% local, 6% regional, and 32% distant.
  
  
  CONCLUSIONS
  This strategy of selective organ preservation was effective in 71% patients with CRT, whereas salvage surgery was required in the remainder. Long-term survival was equivalent in both treatment groups.
authors.affiliation: Division of Surgical Oncology, Landmark Medical Center, Woonsocket, RI, USA. hwanebo@rwmc.org
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Wanebo
authors.forename: Ritesh
authors.initials: R
authors.lastname: Rathore
authors.forename: Prakash
authors.initials: P
authors.lastname: Chougule
authors.forename: Michael R
authors.initials: MR
authors.lastname: DiSiena
authors.forename: R James
authors.initials: RJ
authors.lastname: Koness
authors.forename: Robert G
authors.initials: RG
authors.lastname: McRae
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nigri
authors.forename: Kathy
authors.initials: K
authors.lastname: Radie-Keane
authors.forename: Neal
authors.initials: N
authors.lastname: Ready
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009367:Neoplasm Staging; D009926:Organ Preservation; D017239:Paclitaxel / Q000008:administration & dosage; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel