Preoperative chemotherapy in advanced resectable head and neck cancer: Final report of the southwest oncology group

TLDR

Advanced stage resectable squamous cell carcinoma of the head and neck is a serious disease with limited survival improvement. The Southwest Oncology Group initiated a phase III trial to assess whether inductive chemotherapy improves survival in these patients. The study randomized 158 eligible patients to either conventional treatment (surgery and postoperative radiotherapy) or experimental treatment (induction chemotherapy followed by surgery and radiotherapy), with a median follow‑up of about five years, and evaluated responses, toxicities, complications, compliance, survival, and failure patterns. The trial found an overall chemotherapy response rate of 70%, but median survival was not significantly different between groups, and the final analysis concluded that preoperative chemotherapy does not improve survival in advanced resectable head and neck squamous cell carcinoma.

Abstract

Abstract In 1980, the Southwest Oncology Group instituted a multi‐institutional, prospective, randomized phase III trial to evaluate whether inductive chemotherapy improved survival in patients with advanced stage resectable squamous cell carcinoma of the head and neck. From a group of 158 eligible patients, 76 were randomized to conventional treatment (surgery and postoperative radiotherapy), and 82 were assigned to experimental treatment (induction chemotherapy, surgery, postoperative radiotherapy). Median follow‐up for living patients was approximately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treatment was longer than the time for patients receiving preoperative chemotherapy, although the survival time differences were not statistically significant. This final analysis demonstrates no benefit in survival using preoperative chemotherapy for advanced stage, resectable head and neck squamous cell carcinoma.