Preoperative chemo-radiotherapy in advanced head and neck cancer

In a prospective evaluation, two preoperative courses of methotrexate, bleomycin, and cisplatin combined with 2,000 rad/10 fractions ("chemo-radiotherapy") yielded 78% responses rates in previously untreated advanced head and neck cancer. Similarly staged patients receiving preoperative irradiation of 5,000 rad alone had a 67% response rate. Treatment-related mortality in the chemo-radiotherapy patients was equal to that seen with standard combinations of surgery and preoperative or postoperative irradiation. At 24 months, disease-free survival is 47% with chemo-radiotherapy vs 33% with standard therapy; however, patients benefiting most from the former approach were those with T4 primary lesions or N3a neck nodes.