Safe and effective induction chemotherapy without cisplatin for squamous cell carcinoma of the head and neck: impact on complete response rate and survival at five years, following local therapy.

One hundred forty-seven patients were given a kinetically based combination of vincristine, bleomycin, methotrexate, 5-fluorouracil, and hydrocortisone as initial treatment. Chemotherapy was given on days 1 and 14 before local "curative" therapy with radiation and/or surgery was started on day 28. Response to chemotherapy was assessed in 136 patients. In 89 stage III or IV patients, 57 (64%) responded and 32 (36%) did not. The complete remission (CR) rate following local therapy in patients responding to initial chemotherapy was 74% (42 patients). In patients not responding to initial chemotherapy the CR rate following local therapy was only 40%. This difference is highly significant (P less than 0.001). In 39 stage II patients, 28 (72%) responded to initial chemotherapy and 11 (28%) did not. After local therapy in this group the figures for CR were 70% (19 patients) and 73% (8 patients), respectively. This difference is not significant. Side effects from chemotherapy were minimal and patient compliance was 100%. Of the original 96 eligible patients studied, 1 patient was not assessed and 66 (69%) responded to initial chemotherapy; of these 48 (73%) had a CR following local therapy. Only 15 of the 29 chemotherapy nonresponders (52%) achieved CR following local therapy. This difference is significant (P = 0.03). The overall 5-year survival for these 96 patients is 36%, with chemotherapy responders having the longest median duration of survival.