Induction Chemotherapy in Advanced Head and Neck Cancer Preliminary results of a randomized study

Abstract

From March 1983 to June 1986, 100 patients with locally advanced squamous cell carcinoma of the head and neck were randomized to receive either two courses of chemotherapy prior to local therapy (group A), or local therapy alone (group B). Local treatment consisted of primary radiotherapy in all patients. When a poor response was observed after 55 Gy, surgery was performed. The chemotherapy regimen was a combination of cisplatinum, bleomycin, vindesine, and mitomycin C. The response rate to induction chemotherapy (group A) was 50% for the primary tumor (CR: 10% and PR: 40%). At the end of radiotherapy, the overall tumor response rates in the two groups A and B, were 77% and 79% respectively. Complete disappearance of the primary tumor occurred more often than that of the lymph node metastases. The response rate to induction chemotherapy for lymph node metastases was 27.1% (CR: 9% and PR: 18.1%). An initial major response to chemotherapy predicted subsequent efficacy of irradiation on 90% of the cases, while a failure of chemotherapy had no predictive value in this respect. The survival rates in groups A and B were 66.5% vs. 65.1% at 1 year and 35% vs. 46.2% at 2 years. Local disease-free and disease-free intervals were similar in both groups. A Cox's multi-step regression analysis revealed two significant independant prognostic factors: size of primary tumor and nodal status. After adjustment for these factors, the chemotherapy did not seem to improve the effectiveness of the local treatment in terms of loco-regional control and survival.

Survival Impact of Planned Restaging and Early Surgical Salvage Following Definitive Chemoradiation for Locally Advanced Squamous Cell Carcinomas of the Oropharynx and Hypopharynx

“…Despite repeated evaluation, since the 1970s, studies of induction chemotherapy have failed to demonstrate a significant LC or survival benefit. [7][8][9][10][11][12][13][14][15] In contradistinction, recent studies clearly demonstrate a survival benefit for concurrent chemoradiation therapy in comparison with RT alone. 16 -20 Many nonsurgical organ preservation protocols have also justified the use of induction chemotherapy to reduce distant metastases, in addition to selecting patients for nonsurgical therapy as described earlier, but this strategy may be of questionable benefit based on the results of RTOG 91-11, which indicate a reduced survivorship in patients experiencing initial local failure and no benefit from induction therapy.…”