A LONG-TERM ASSESSMENT OF ADJUVANT CHEMOTHERAPY ON OUTCOME OF PATIENTS WITH EXTRACAPSULAR SPREAD OF CERVICAL METASTASES FROM SQUAMOUS CARCINOMA OF THE HEAD AND NECK

BACKGROUND. Extracapsular spread (ECS) of cervical lymph node metastas es of squamous cell carcinoma from head and neck sites portend poor pr ognosis. Therefore, a program of combined surgery, postoperative irrad iation therapy, and adjuvant methotrexate and 5-fluorouracil (5-FU) wa s initiated in 1982 for such patients. METHOD. All patients operated o n between June 1982 and December 1992 by the full-time faculty of the Department of Otolaryngology at the University of Pittsburgh School of Medicine were eligible and reported in this trial. All patients had n egative surgical margins of excision of the primary carcinoma, and his tologic evidence of cervical metastases with ECS. Postoperative irradi ation included 50-60 cGy for 5 to 6 weeks followed by methotrexate and 5-FU administered on an outpatient basis on days 1 and 8 every 21 day s. All patients were followed for 30 or more months for evidence of re current disease. RESULT. A total of 371 patients met eligibility crite ria. Of this group, 53 (14%) were treated with surgery only, 187 (50%) received surgery and postoperative irradiation, and 131 (35%) receive d surgery, irradiation therapy, and chemotherapy. The primary site, ex tent of nodal involvement, and stage of the three patient groups were similar. However, performance status (Karnofsky) was best in the patie nts who received chemoradiation (average 90) when compared with those who received surgery and irradiation (average 80) or surgery only (ave rage 70). Absolute disease free survival rate (30 months) was 9.5% in patients treated with surgery only, 34% in patients treated with surge ry plus irradiation, and 53% in patients treated with surgery, irradia tion, and chemotherapy. When adjusted for patients who died of intercu rrent disease with less than 30 months follow-up, survival rates becam e 17%, 40%, and 58%, respectively. These differences are highly signif icant (P < 0.001). CONCLUSION. Results of this study suggest that post operative chemoradiation may improve survival in patients with ECS of cervical metastases. Compliance with the chemoradiation was suboptimal and suggests that improved strategy must be developed. (C) 1996 Ameri can Cancer Society.