OBSERVATIONS ON CONTROL OF N2 AND N3 NECK DISEASE IN SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK BY INTRAARTERIAL CHEMORADIATION

Patients with head and neck squamous cell cancer with N2 and N3 neck d isease have a poor prognosis and are at risk to fail regionally despit e combined surgery and radiation. Twenty-two patients with N2 and N3 n eck disease land T3-4 primaries) were treated with intra-arterial, hig h-dose cisplatin (CDDP), 150 mg/m(2) per week for 4 weeks, and concurr ent radiation. All patients were followed for at least 2 years or unti l death from any cause. Twenty patients had a complete response at the primary site. Two of the 20 with a complete response later had a neck recurrence and died. Five patients with palpable nodes after treatmen t underwent fine-needle aspiration (FNA), one of which was positive an d two suggestive of cancer. Six neck dissections were performed in thi s group, only two of which had positive nodes. This chemoradiation pro tocol may offer reasonable control of N2 and N3 neck disease in advanc ed head and neck squamous cell cancer, Neck dissection appeared to be necessary in only those patients with nodes 8 weeks after treatment in whom FNA was positive or suggestive of cancer. Because of the relativ ely small size of this series, additional accrual and monitoring of su ch patients is planned.