Summary Meta-analysis of the published results from 54 randomised controlled trials of adjuvant chemotherapy in head and neck cancer suggests that chemotherapy might increase absolute survival by 6.5% (95% confidence interval 3.1-9.9%). The odds ratio in favour of chemotherapy is 1.37 (95% confidence interval 1.24-1.5). Single-agent chemotherapy given synchronously with radiotherapy increased survival by 12.1% (95% confidence interval 5-19%). The benefit from neoadjuvant chemotherapy was less: a rate difference of 3.7% (95% confidence interval 0.9-6.5%). The results suggest that the investigation of optimal agents and scheduling for synchronous radiotherapy and chemotherapy might still be important in clinical trials in head and neck cancer.Keywords: overview; randomised trials; head and neck cancer Attitudes towards cytotoxic chemotherapy for squamous carcinomas of the head and neck range from enthusiasm (Dimery and Hong, 1993) to disdain (Tannock and Browman, 1986;Taylor, 1987). Response rates to chemotherapy are high, but this responsiveness does not appear to translate into durable benefit in terms of survival. Recent metaanalyses of adjuvant chemotherapy for squamous cell carcinoma of the head and neck failed to show any benefit from such treatment (Stell and Rawson, 1990;Stell, 1992). However, several randomised trials published subsequently have been reported as showing benefit from adding chemotherapy to standard therapy. In order better to define the possible role for chemotherapy and to suggest possibly fruitful avenues for exploration, a further meta-analysis of published randomised clinical studies of adjuvant chemotherapy in head and neck cancer has been performed.The primary purpose of this overview was to discover whether the addition of chemotherapy to definitive standard therapy improved survival in patients with cancer of the head and neck. Secondary objectives included an assessment of whether the timing of chemotherapy, before, during or after standard therapy, was important; a specific assessment of the effectiveness of platinum/5-fluorouracil (5-FU) regimens; an evaluation of single-agent chemotherapy given synchronously with radiotherapy; an assessment of the effect of chemotherapy upon locoregional control rates; an assessment of the effect of chemotherapy upon the occurrence of distant metastases. Materials and methodsA structured search was conducted to identify randomised clinical trials of chemotherapy in head and neck cancer. A trial was suitable for inclusion if it fulfilled the following criteria. *

We describe the use of remifentanil in a woman with severe pre-eclampsia who presented for emergency caesarean section. Remifentanil was effective in obtunding the hypertensive response to laryngoscopy and intubation. Previous studies have found no significant adverse effects of remifentanil on the neonate. With its short duration of action, the use of this new opioid has several potential advantages in the above setting. Further studies are required to explore the use of remifentanil as an adjunct to obstetric general anaesthesia.

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