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Treatment of advanced squamous cell caricinomas of the head and neck with initial combination chemotheraphy prior to surgery and/or radiotheraphy: five-year survival data

Published online by Cambridge University Press:  29 June 2007

H. J. Shaw ,
L. A. Price  and
Bridget T. Hill
H. J. Shaw
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ.
L. A. Price
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ.
Bridget T. Hill
Affiliation:
The Head and Neck Unit, The Royal Marsden Hospital, London SW3 6JJ. Laboratory of Cellular Chemotherapy, Imperial Cancer Research Fund, London WC2A 3PX.
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Abstract

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20–30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in non-responders (54 per cent) p<0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p<0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p<0.01). Survival data are available for a mean follow-up time of 48 months (range 12–78 months). Chemotherapy responders have a longermedian survival than non-responders, 33 versus 20 months (p<0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p<0.001). Actuarial analyses indicate that at five years 46 percent of patients in complete remission are alive, compared with only 9 per cent with residual disease. Since chemotherapy responders are significantly more likely to achieve a complete remission than non-responders (p<0.05), objective response to this schedule of chemotherapy is a good prognostic sign.

Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 98 , Issue 1 , January 1984 , pp. 75 - 82
Copyright
Copyright © JLO (1984) Limited 1984

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