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Adjuvant Chemotherapy in Advanced Head and Neck Cancer

^a Hematology-Oncology Unit, ^b Protocol Office, ^c Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA; ^d Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA

Correspondence: Philip C. Amrein, M.D., Hematology-Oncology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Telephone: 617-726-8748; Fax: 617-724-1137; e-mail: Amrein.Philip{at}MGH.Harvard.Edu

Purpose. Chemotherapy has been tested extensively in conjunction with standard therapy in the treatment of head and neck cancer, primarily in the form of neoadjuvant chemotherapy, but few trials have shown a survival benefit. Although a few studies have suggested that adjuvant chemotherapy given after standard treatment may improve survival, to date these trials have been troubled by various problems in design and dosing. The purpose of our trial was to determine the feasibility of giving moderately intensive chemotherapy exclusively after standard therapy, and to determine whether survival appeared to be improved as measured against historical data.

Methods. We used adjuvant chemotherapy in two groups of patients with squamous cell carcinoma of the head and neck: group A consisted of 46 patients with newly diagnosed stage III and IV disease, and group B consisted of 46 patients with relapsed disease having been treated with salvage surgery. In all patients, the intended adjuvant chemotherapy consisted of two cycles of combination cisplatin, bleomycin, and infusional 5-fluorouracil (5-FU) given three weeks apart, followed by four cycles of bolus methotrexate, 5-FU, and bleomycin given every two weeks.

Results. In group A, the two-year survival was 72%. In group B, the two-year survival was 58%.

Conclusion. Compared to the vast majority of similarly staged patients with head and neck cancer reported in the literature, the survival of our group seemed considerably better, suggesting that a definitive randomized study testing this schedule of adjuvant chemotherapy is warranted.

Key Words. Adjuvant chemotherapy • Head and neck cancer • Cisplatin • Bleomycin • 5-Fluorouracil • Methotrexate