Preoperative chemotherapy in advanced resectable head and neck cancer: Final report of the southwest oncology group

Abstract

In 1980, the Southwest Oncology Group instituted a multi-institutional, prospective, randomized phase III trial to evaluate whether inductive chemotherapy improved survival in patients with advanced stage resectable squamous cell carcinoma of the head and neck. From a group of 158 eligible patients, 76 were randomized to conventional treatment (surgery and postoperative radiotherapy), and 82 were assigned to experimental treatment (induction chemotherapy, surgery, postoperative radiotherapy). Median follow-up for living patients was approximately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treatment was longer than the time for patients receiving preoperative chemotherapy, although the survival time differences were not statistically significant. This final analysis demonstrates no benefit in survival using preoperative chemotherapy for advanced stage, resectable head and neck squamous cell carcinoma.

Adjuvant chemotherapy in head and neck cancer

“…Four trials did not specify whether eligible patients were excluded from randomisation. Twelve authors described exclusion of eligible patients before randomisation, but only five authors (Ervin et al, 1987;Fu et al, 1987;Holoye et al, 1985;Schuller et al, 1988;Toohill et al, 1987) give details of how many eligible patients were excluded. These latter five trials contained a total of 648 patients, 134 (20.7%) of eligible patients were excluded before randomisation.…”

“…This left 23 randomised controlled trials with survival data (Arcangeli et al, 1983;Cachin et al, 1977;Ervin et al, 1987;Fazekas et al, 1980;Fu et al, 1987;Gollin et al, 1972;Gupta et al, 1987;Head and Neck Contracts Program, 1987;Holoye et al, 1985;Hussey & Abrams, 1975;Knowlton et al, 1975;Lo et al, 1976;Martin et al, 1986;Nissenbaum et al, 1984;Pearlman et al, 1985;Petrovich et al, 1981;Rentschler et al, 1987;Schuller et al, 1988;Stefani et al, 1971;Stefani & Chung, 1980;Stell et al, 1983;Stolwijk et al, 1983;Taylor et al, 1985;Toohill et al, 1987;Vermund et al, 1985 Gollin et al (1972) and a subgroup of patients with tumours of the oral cavity and oropharynx, with additional patients, was later reported by Lo et al (1976). The data for tumours of the mouth and oropharynx are taken from the latter paper, and those for other sites from the former, but the two are otherwise treated as one trial.…”

“…Also some believe that it might increase the rate of distant metastases (Vermund et al, 1985), and some that it might reduce it (Schuller et al, 1988). Therefore data for site of failure were extracted when they were available.…”

“…Toxicity was reported fully and graded in only three papers (Ervin et al, 1987;Fu et al, 1987;Schuller et al, 1988). Nine papers gave details of toxicity, with no grading scheme, eight papers dismissed it in a few words, e.g.…”

State-of-the-art management of locally advanced head and neck cancer

“…This was presumably from micrometastatic disease that local therapy or lower dose chemotherapy as part of chemoradiation would not adequately treat. This theoretical argument has been tested in several trials that have been unable to show a consistent survival benefit Schuller et al, 1988;Paccagnella et al, 1994;El-Sayed and Nelson 1996;Domenge et al, 2000;Pignon et al, 2000). (Table 4a).…”