COMBINATION CHEMOTHERAPY AS INDUCTION THERAPY FOR ADVANCED RESECTABLEHEAD AND NECK-CANCER

Fifty-four previously untreated patients with locally advanced resecta ble squamous cell carcinoma of the head and neck (SCCHN) were enrolled into a prospective randomized controlled trial to evaluate whether in duction chemotherapy improves the disease-free survival compared to th e standard treatment (surgery + radiation). Thirty patients received c hemotherapy, which consisted of cisplatin 20 mg/m(2) day 1-5, bleomyci n 10 mg/m(2), continuous infusion from day 3-7, and methotrexate 40 mg /m(2) given on day 15 and day 22. The cycle was repeated on day 29 for two cycles. Twenty patients completed chemotherapy courses. Overall r esponse rate was 77% (23 of 30). No survival improvement was observed. Kaplan-Meier analysis indicated survival (and 95% confidence interval ) at 3 years was 57% (29%-84%) for the control group and 60% (34%-87%) for the chemotherapy group, and 57% (29%-84%) and 45% (12%-78%) at 4 years (P = 0.736). However, patients who had a complete response were significantly better in terms of long-term survivors (5 of 7 patients were still alive), in contrast to patients who had partial responses a mong whom only 4 of 16 were alive. Toxicities of this induction protoc ol are tolerable; one chemotherapy-related death occurred from profoun d thrombocytopenia. If efforts in determining a chemotherapy-sensitive patient were successfully established, along with a better sequence a nd the discovery of new and safter drugs, survival of SCCHN should be much improved. (C) 1995 Wiley-Liss, Inc.