Induction chemotherapy in advanced head and neck tumors: Results of two randomized trials

Induction chemotherapy and radiation therapy for T4 oropharyngeal carcinoma

“…Therefore, patients with neck stage N2-N3 may be more likely to benefit from induction chemotherapy than are patients with neck stage N0 − N1. Most patients (48%-78%) in the prospective randomized studies had N0-N1 neck stage and were at relatively low risk for developing distant metastases [11,[13][14][15]. Patients most likely to benefit from induction chemotherapy may be those with AJCC stage IV tumors (T4 and/or N2-N3), but most studies evaluating induction chemotherapy have included stage III tumors.…”

“…Therefore, it may be beneficial to treat stage T4 oropharyngeal lesions with induction chemotherapy because they have a < 50% local control rate when treated with radiation alone; and it may not be beneficial to treat stage T3 oropharyngeal lesions with induction chemotherapy because they have a 65%-70% local control rate when treated with radiation therapy alone [20]. Most patients (62%-95%) in the prospective randomized studies evaluating induction chemotherapy had stage T3 or smaller primary lesions and therefore were at relatively low risk for local-regional failure [11,[13][14][15], which would make it more difficult to detect a potential benefit from induction chemotherapy. Patients with stage N0 − N1 neck disease have a distant metastasis rate of Յ 10%, whereas patients with stage N2-N3 disease have a distant metastasis rate of 20%-30% [21].…”

“…However, these studies usually included a variety of primary sites, including oral cavity, oropharynx, hypopharynx, and larynx [12,14,15]. Tumors arising from these sites have different natural histories and different responses to therapy and should probably be evaluated separately.…”

Chemotherapy and Biologic Therapy for Squamous Cell Cancers of the Head and Neck

“…[4][5][6][7][8][9][10][11] Chemotherapy regimens were mainly cisplatin based combinations with cisplatin and 5-FU dominating the literature in the 1990s. In spite of high antitumor activity of the induction chemotherapy, all but two trials did not show a benefit of induction chemotherapy for locoregional control or overall survival.…”

Neoadjuvant Chemotherapy Followed by Radiotherapy for Laryngeal Cancer

“…A significant survival advantage was demonstrated among patients who achieved complete clinical and pathological response following platinum and fluoruracil chemotherapy. (7,(11)(12)(13) In the study by Jacobs et al (14) and Karp et al (15) were the first to incorporate this preoperative chemotherapy treatment as a means to select patients for non-surgical definitive treatment. Based on these findings, the first randomized study of organ-preservation therapy for laryngeal cancer was conducted by the Department of Veterans Affairs (VA) Laryngeal Cancer Study Group.…”