Treatment of advanced squamous cell carcinomas of the head and neck with initial combination chemotherapy prior to surgery and/or radiotherapy: five-year survival data.

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20-30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in nonresponders (54 per cent) p less than 0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p less than 0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p less than 0.01). Survival data are available for a mean follow-up time of 48 months (range 12-78 months). Chemotherapy responders have a longer median survival than non-responders, 33 versus 20 months (p less than 0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)