INDUCTION CHEMOTHERAPY PLUS SURGERY AND OR RADIATION IN PATIENTS WITHLOCALLY ADVANCED HEAD AND NECK CANCERS - RETROSPECTIVE ANALYSIS OF 125 PATIENTS/

The prognosis of locally advanced cancers of the head and the neck is pejorative, particularly when nodal involvement is present. In order t o improve local control and to reduce distant failures, we have treate d stages III and IV patients with induction chemotherapy. From May 198 6 to November 1992, 125 patients with squamous cell carcinoma of the h ead and neck were treated by induction chemotherapy: cisplatine (100 m g/m(2) at J1) and 5FU (1 g/m(2) from J1 to J5 in continuous infusion) every 21 days subsequent local therapy consisted of surgery for patien ts with resectable disease, and/or radiotherapy. One hundred and ninet een patients were assessable (110 men and 9 women) with a median age o f 57 years (range: 36-78). All patients had performans status inferior or equal to 2. According to the TNM of UICC classification 50 patient s were state IV (42%), 61 stage III (51%), 7 stage II (6%) and a stage I (1%). One hundred (84%) patients have received at least 3 cycles of chemotherapy. Seventy-four patients (62%, IC: 60.4-63.5) had clinical objective response (complete response (CR) or partial response (PR)) with 24 patients (20%) CR and 50 patients (42%) PR. Local therapy incl uded surgery in 81 patients (68%) and radiotherapy alone in 42 patient s (35%). Overall, 103 patients (87%) were rendered clinically disease- free by treatment on this protocol. The toxicities of cisplatine and 5 -FU chemotherapy consisted predominantly of myelosuppression (5%) and renal toxicities (4%) and were moderate as described for this combinat ion. At a median follow-up of 32 months, the median survival is 38 mon ths (CI 95%, 18-54 months), and the median time to progression is 62 m onths. The oropharynx localization reached statistical significance fo r survival rates (Log-rank test, p=0.02).