Combination of cis-platinum and bleomycin prior to surgery and/or radiotherapy compared with radiotherapy alone for the treatment of advanced squamous cell carcinoma of the head and neck

Abstract

Forty-one patients with unresectable Stage IV head and neck squamous cell carcinoma were treated with combined modality therapy (CM) consisting of induction chemotherapy followed by surgery and/or radiotherapy (RT). Treatment and survival results are reported and compared to results obtained in treating 41 historic controls with RT alone. Treatment groups are well matched with respect to age, site of primary, size of primary and nodal status. Two patients in the CM group had previous treatment (surgery or RT). All patients in the control group were previously untreated. No patient had distant metastases. Patients in the CM group received cis-platinum (DDP) 120 mg/m2 on days 1 and 22 with prehydration and mannitol diuresis and bleomycin 15 m̈/m2 as a continuous infusion between days 3–9 started after a 15 u/m2 IV push. Patients underwent reendoscopy two weeks after completing chemotherapy to evaluate response. Subsequent surgery and/or radiotherapy were administered depending on tumor resectability after chemotherapy. The complete response (CR) rate to induction chemotherapy was 17% and the partial response (PR) rate was 53% for an overall major response rate of 70%. The CR rate at the completion of all therapy was 73% for the CM group and 15% for the controls. Median follow-up of the CM group is 20 months; 53% of patients are alive and 41% are disease-free. Median survival has not been reached; projected survival is 29 months. Median follow-up of the control group is 4.8 months; median survival is 4.5 months with 5% of patients alive and disease-free at 24 months. Complete responders in the control group have an overall and disease-free survival of 18 and 15 months respectively. Failure to attain a CR was associated with a median survival of five and three months for the CM and control groups respectively. Induction chemotherapy with DDP and bleomycin infusion followed by surgery and/or radiotherapy appears to be associated with a higher CR rate and prolonged survival compared to RT alone.