Induction chemotherapy, followed by surgery and/or radiotherapy was utilized in patients with advanced squamous cell carcinoma of the head and neck. During these trials, the authors observed that response to chemotherapy predicts further response to subsequent radiotherapy. This study was comprised of 57 patients with 60 separate neoplasms who demonstrated less than complete response (partial or no response) to initial treatment with a combination chemotherapy containing cisplatin. Subsequently radiotherapy, either 5000 rad preoperatively or 6600 rad as definitive therapy, was employed. Forty‐one of the 42 tumors with initial partial response to chemotherapy also responded to radiotherapy (97.6%). Only one of the 18 tumors that initially failed to respond to chemotherapy subsequently responded to radiotherapy (5.5%). This observation suggests that patients with head and neck cancer sensitive to initial chemotherapy share parameters that are also radiation sensitive.

Seventy‐seven patients with squamous cell carcinoma of the oropharynx were treated by preoperative radiation therapy (4000–5000 rad) followed by surgical resection. The original biopsy specimens were evaluated for degree of keratinization, nuclear pleomorphism, frequency of mitoses, inflammatory response, vascular invasion, and pattern of invasion. Multivariant analysis (Cox regression model) and life table survival function were used to determine the relative contributions of the clinical and histologic parameters to patient outcome. The results were as follows: (1) large tumor size, nodal metastases, and male sex were found to be predictive of a poorer survival (P = 0.004, 0.004, 0.0167, and 0.0237, respectively); and (2) an analysis of a combination of clinical and histologic parameters demonstrated that the pattern of invasion was the only histologic factor that was predictive of survival (P = 0.0436). Neoplasms invading as large cohesive aggregates indicated a better prognosis than neoplasms invading as thin, irregular cords or individual cells. Restricting the statistical evaluation to only histologic factors (excluding clinical factors) demonstrated that increased frequency of mitoses also correlated with poor survival (P = 0.0218). Further restriction of the analysis to T2 and T3 neoplasms that have similar survival times indicated that both frequency of mitoses and pattern of invasion were of prognostic value in predicting survival (P = 0.0127 and 0.0168, respectively).

We conclude that the combination of estramustine and VP-16 is an active oral regimen in hormone-refractory prostate cancer.

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