IMPROVED SURVIVAL WITH PREOPERATIVE CHEMOTHERAPY FOLLOWED BY RESECTION UNCOMPROMISED BY TUMOR RESPONSE FOR ADVANCED SQUAMOUS-CELL CARCINOMAOF THE HEAD AND NECK

BACKGROUND: A total of 93 patients were treated with one of two preope rative chemotherapy regimens over a 15-year period. The study supports the importance of strict adherence to guidelines for ablative surgery . METHODS: A single surgeon performed the surgery and evaluated each p atient prior to treatment. The extent of the planned operation was doc umented. RESULTS: The 5-year absolute survival of 88 patients who comp leted the protocol was estimated at 55%. The 40 cisplatin/5-fluorourac il-treated patients exhibited a significantly better outcome than the 48 cisplatin/bleomycin-treated patients (76% versus 43%, respectively) . Comparison of a subset of 37 patients with a matched group from the standard control arm of the Head and Neck Contracts Program demonstrat ed a statistically significant improvement in overall survival over st andard treatment. CONCLUSIONS: These data suggest that strict adherenc e to preoperative chemotherapy planning of ablative uncompromised surg ery contribute to improved survival. Selective rather than routine pos toperative radiotherapy may be advantageous.