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Pathology of surgery after induction chemotherapy: an analysis of resectability and locoregional control
Author(s) -
Norris Charles M.,
Fabian Richard L.,
Miller Daniel,
Clark John R.,
Ervin Thomas J.,
Fallon Barbara,
Tuttle Stephanie A.,
Frei Emil
Publication year - 1986
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-198603000-00011
Subject(s) - medicine , induction chemotherapy , chemotherapy , bleomycin , surgery , radiation therapy , stage (stratigraphy) , radical surgery , head and neck cancer , head and neck , cancer , paleontology , biology
At the Dann‐Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis‐platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: 1. predictability of, and conversion to, resectability during induction chemotherapy; 2 . ease of surgical technique and intraoperative assessment; 3. patterns of pre‐op and postop risks and complications; 4. gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; 5. patterns of locoregional control or failure related to treatment variables. The issues subsequently addressed include: how does chemotherapy affect the operative candidacy and resectability of proposed surgical patients? Could, or should surgery be eliminated in the management of some patients treated with induction chemotherapy? Can less radical surgery be contemplated in patients significantly “downstaged” by prior chemotherapy treatment? Is increased locoregional or distant metastatic control observed in these patients? What is the role of surgery in the responder to chemotherapy?