Triple therapy for advanced cancer of the head and neck

Eighty-two patients with advanced cancer of the head and neck have been treated with sequential administration of methotrexate and cisplatin. Methotrexate was given orally (50 mg/sq m). Cisplatin was given intravenously 24 hours later. Treatment was repeated four times at weekly intervals. This method of administration is based on laboratory evidence, including cell kinetic studies. Forty-three patients were operated on. Those with involved or close surgical margins or with more than one cancerous neck node were also treated with therapeutic postoperative radiation therapy. Twenty-two patients were treated with only radiation therapy. After surgery and/or radiation therapy, patients were randomly selected as to who would receive further chemotherapy or who would be under observation only. Twenty-two patients are still in the early phases of treatment and follow-up, so their conditions could not be evaluated. Early results indicate a 64% response to initial chemotherapy and no increase in operative difficulty, morbidity, or mortality.