Evaluation of a qualitative regression grading as a prognostic factor in advanced head and neck cancer after neoadjuvant radiochemotherapy

Background: Multimodal therapeutic strategies gain importance in locally ad vanced squamous cell carcinoma of the head and neck. Quantitative regressio n grading can be traced as an independant prognostic parameter in the histo logical examination in many neoadjuvantly treated cancers. Various regressi on systems have been suggested. We propose an easy to apply and economical score that seems to have a significant prognostic value in squamous cell ca rcinoma of the head and neck. Patients and Methods: 43 patients with Stage IV squamous cell carcinoma of the head and neck have been treated neoadjuvantly with two cycles chemother apy (ifosfamide 1.5 g/m(2) day 1-5 with mesna [300 mg/m(2)], cisplatin 60 m g/m(2) day 5, second cycle day 22). Hyperfractionated accelerated radiother apy (30 Gy) was given from day 29 on. We divided the resected tumors histol ogically as follows: Grade I - no tumor cells to be identified, Grade II - necrosis, Grade III - partial destruction of the carcinoma, Grade IV-vital carcinoma. Results: After 1 year the overall survival amounted to 79%, after 2 years 5 6%. A significant correlation could be established between qualitative tumo r regression and survival. The 1-year survival depended on the regression o f the primary as follows: 94% in Grade I, 80% in Grade II, 60% in Grade III and 56% in Grade IV. For the P-year survival: 76%, 40%, 40%, 11% (p < 0.01 ). The results were similar regarding the neck dissections. Conclusions: After radiochemotherapy the histological regression is a signi ficant prognostic factor of survival. A simple system with four subgroups i s suggested which seems to be of a high prognostic value, We discuss to int ensify the treatment for patients with good regression after neoadjuvant th erapy for a further reduction of recurrence.