A randomized trial of neoadjuvant vs concomitant chemotherapy vs radiotherapy alone in the treatment of stage IV head and neck squamous cell carcinoma

• Published in: European archives of oto-rhino-laryngology 1992-06, Vol.249 (4), p.211-215
• Main Authors: SALVAJOLI, J. V, MORIOKA, H, TRIPPE, N, KOWALSKI, L. P
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Hypopharyngeal Neoplasms - drug therapy; Hypopharyngeal Neoplasms - pathology; Hypopharyngeal Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Mouth Neoplasms - drug therapy; Mouth Neoplasms - pathology; Mouth Neoplasms - radiotherapy; Neoplasm Staging; Oropharyngeal Neoplasms - drug therapy; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Prospective Studies; Radiotherapy Dosage; Tumors
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/BF00178472

Treatment results of irradiation as a single treatment for advanced stage IV unresectable head and neck cancer remains uniformly poor and apparently has not changed with the most recent improvements in oncological care. Despite several negative results of randomized studies, neoadjuvant or concomitant chemotherapy and radiotherapy seems to improve the number of complete responses and also the duration of disease-free survival. The present study was designed to determine the feasibility, potential risks and benefits of the two methods of combined treatment and radiotherapy alone on the management of advanced unresectable squamous cell carcinoma of the upper respiratory and digestive system. From 1983 to 1986, 90 patients entered the trial. Thirty patients were randomized to each study group: radiotherapy alone (70 Gy); neoadjuvant chemotherapy (vinblastine, mitomycin, cisplatin, and bleomycin) and radiotherapy; concomitant chemotherapy (cisplatin and bleomycin) and radiotherapy. An increased frequency of complete responses (33%) was seen in patients treated with the two different combinations of chemotherapy and irradiation compared to irradiation alone (10%). However, toxicity was more common in patients treated with the two modalities of combined treatment and there were no differences in overall survival rates (P = 0.706).