Preoperative reductive chemotherapy for locally advanced carcinoma of the oral cavity, oropharynx, and hypopharynx.

Recent reports have documented that five year survivals have not really improved as a result of combined therapy programs utilizing surgery and radiation therapy. The pattern of treatment failure seems to have changed in that such combined programs offer improved local and regional control but only to have patients develop distant metastases. The need for some form of systemic treatment was obvious. In 1977, a pilot study was initiated at the Ohio State University to evaluate a particular four drug combination and its effectiveness against squamous cell carcinoma of the head and neck. The initial results revealed an acceptable risk-benefit ratio to evaluate this regimen in a group of patients who had previously received no treatment. This report details the final results of the pilot study designed to evaluate response rates in previously untreated locally advanced squamous cell carcinoma of the oral cavity, oropharynx, and hypopharynx. During the 15 month duration of this study there were 58 patients who were evaluable. The overall response to a combination of cis-platinum, vincrinstine, methotrexate, and bleomycin was 66%. All toxicities occurred in less than 10% of the patients except for nausea and vomiting, which occurred to a mild to moderate degree in three quarters of the patient population. There was no increase in surgical or radiotherapeutic complications as a result of utilizing initial chemotherapy. This four-drug combination is now being evaluated to test its impact on survival as a Southwest Oncology Group study.