Predictive factors for tumor response to preoperative chemotherapy in patients with head and neck squamous carcinoma: The head and neck contracts program

Abstract

The high tumor response rates associated with intensive chemotherapy in previously untreated patients with advanced head and neck squamous cell carcinoma (HNSCC) led to the initiation of a multi‐institutional National Cancer Institute trial. This trial used preoperative chemotherapy in patients with resectable Stage III and IV squamous cell carcinoma of the oral cavity or larynx/hypopharynx. Response rates, toxicity, and a variety of patient and tumor characteristics were analyzed to determine which factors might be useful in predicting tumor response to preoperative chemotherapy. Two hundred eighty‐two patients received one course of preoperative cisplatin and bleomycin chemotherapy and were evaluable. There were 22 complete responses (CR) and 114 partial responses (PR) at the primary site (48% response rate). Of 197 patients with clinically positive regional adenopathy, 29 CRs and 73 PRs were observed (52%). Toxicity associated with the chemotherapy regimen was minimal. Primary tumor and regional node responses to chemotherapy were strongly correlated. No significant differences were found in primary or nodal response rates with respect to differing tumor site, stage, histologic differentiation, patient performance status, nutritional status, leukocyte count, hemoglobin level, age, sex, or alcohol use. Primary tumor response, however, was significantly related to T classification (P = 0.048). Nodal response was strongly associated with N classification and nodal size (P = 0.02 and P = 0.075, respectively). These findings suggest that, of the patient and tumor characteristics analyzed, none were more useful in predicting tumor response than clinical tumor staging parameters.

Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders

“…4; P ϭ 0.03). Furthermore, the chemosensitivity of invasive squamous cell carcinomas of the upper aerodigestive tract reportedly has been related statistically to the T stage of the tumor: Wolf et al, 15 , in a prospective, randomized, multicentric trial based on 282 patients with resectable Stage III and IV squamous cell carcinoma, noted that complete clinical responses were more common in patients with T1 or T2 tumors compared with patients with T3 or T4 tumors. Therefore, from the beginning in our series, we believe that Group II patients had a higher risk for an incomplete histologic recurrence after the chemotherapy-alone regimen and an increased local failure rate compared with Group I patients.…”

Management of the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer

“…Although the primary and regional responses are associated, this association is not always reliable, and the primary response should be evaluated separately from the regional response. 10,15 The implication is that in patients undergoing organ-sparing treatment, the primary and neck tumors should be evaluated and treated separately. As suggested years ago by Adelstein et al, 16 it may be appropriate, after chemoradiotherapy, to limit the surgery to the neck when a CR has occurred at the primary site.…”

“…13 As with induction chemotherapy 6,7,10,12 and with radiotherapy, 17 achieving a CR improves the prognosis. Wolf et al 15 has stated that it is unclear whether obtaining a CR is a result of therapy or selection of tumors with a better prognosis regardless of therapy. In our series, the rate of CR differed between the groups, so it seems that the treatment is at least partially responsible for the response.…”

Preliminary results of pre-radiation neck dissection in head and neck cancer patients undergoing organ preservation treatment

“…Another important concern is that the tumor in the primary site and the regionally metastasized tumor may show different biologic behaviors [11,16,19]. As shown in Table II, response to chemotherapy at the primary site and the neck do not show any correlation (P0.48).…”