Premium
Combination chemotherapy as induction therapy for advanced resectable head and neck cancer
Author(s) -
Maipang Tanaphon,
Maipang Matinee,
Geater Alan,
Panjapiyakul Chingyiam,
Watanaarepornchai Somchai,
Punperk Supaporn
Publication year - 1995
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930590203
Subject(s) - medicine , chemotherapy , induction chemotherapy , bleomycin , head and neck cancer , surgery , methotrexate , radiation therapy , cisplatin , prospective cohort study , cancer , confidence interval , randomized controlled trial , oncology
Fifty‐four previously untreated patients with locally advanced resectable squamous cell carcinoma of the head and neck (SCCHN) were enrolled into a prospective randomized controlled trial to evaluate whether induction chemotherapy improves the disease‐free survival compared to the standard treatment (surgery + radiation). Thirty patients received chemotherapy, which consisted of cisplatin 20 mg/m 2 day 1–5, bleomycin 10 mg/m 2 , continuous infusion from day 3–7, and methotrexate 40 mg/m 2 given on day 15 and day 22. The cycle was repeated on day 29 for two cycles. Twenty patients completed chemotherapy courses. Overall response rate was 77% (23 of 30). No survival improvement was observed. Kaplan‐Meier analysis indicated survival (and 95% confidence interval) at 3 years was 57% (29%‐84%) for the control group and 60% (34%‐87%) for the chemotherapy group, and 57% (29%‐84%) and 45% (12%‐78%) at 4 years (P = 0.736). However, patients who had a complete response were significantly better in terms of long‐term survivors (5 of 7 patients were still alive), in contrast to patients who had partial responses among whom only 4 of 16 were alive. Toxicities of this induction protocol are tolerable; one chemotherapy‐related death occurred from profound thrombocytopenia. If efforts in determining a chemotherapy‐sensitive patient were successfully established, along with a better sequence and the discovery of new and safter drugs, survival of SCCHN should be much improved.