CA: A Cancer Journal for Clinicians, Vol 33, 139-144, Copyright
© 1983 by American Cancer Society
Adjuvant Chemotherapy in the Management of Stage III and IV Tumors of the Head and Neck
George J. Bosl M.D.1
1 Assistant Attending Physician in the Solid Tumor Service of the Department of Medicine of Memorial Sloan-Kettering Cancer Center, and Assistant Professor of Medicine at Cornell University Medical College, in New York, New York.
There are no available data from randomized controlled trials to support the use of systemic chemotherapy with either single agents or drug combinations prior to local therapy for stage III and IV epidermoid carcinoma of the head and neck. Such treatment should be considered investigational. So far, the desired results from this approach have been thwarted by unexpectedly short responses, no important changes in survival, and, to a much lesser extent, the toxicity of treatment. On the other hand, if such therapy could be shown to be efficacious, the toxicity would be come more acceptable.
Perhaps the biggest problem has been the absence of prospective randomized trials. A cooperative study under contract to the Division of Cancer Treatment of the National Cancer Institute has recently been closed to additional patients. This prospective trial randomized patients with operable stage III and IV epidermoid carcinomas from six primary head and neck sites to one of three arms:
•Cisplatin plus bleomycin, followed by standard local therapy.
•Standard local therapy alone.
•Cisplatin plus bleomycin, followed by standard local therapy, followed by six months of cisplatin.
The results of this study are not yet available. When the data mature, the results will set the tone for future clinical investigation in this area. Equally as important, however, it will provide direction for the practicing physician.
Other areas of research may be fruitful. The use of simultaneous chemotherapy and radiation therapy is under investigation. New drugs will continue to be [SEE TABLE 1 IN SOURCE PDF.] analyzed in clinical trials. Most importantly, future investigators should consider randomized trials for new therapy after pilot studies show reasonable success and tolerable toxicity. Firm recommendations may then be possible about the value of adjunctive chemotherapy in patients with head and neck cancer.
