Lack of survival advantage in patients with advanced squamous cell carcinomas of the oral cavity receiving neoadjuvant chemotherapy prior to local therapy, despite achieving an initial high clinical complete remission rate

Abstract

Subset analyses have been performed on 50 patients with squamous cell carcinomas of the oral cavity from our earlier series of 208 patients with advanced, previously untreated head and neck tumors (J Clin Oncol 1986;4:1340-7). Forty patients (80%) responded to two initial courses of Schedule A chemotherapy. Side effects were minimal. After definitive local therapy the final complete remission (CR) rate was 76%. Neither chemotherapy response, nor achievement of final CR was significantly affected by stage, T or N status, sex, or histologic grade. With a median follow-up of 11.6 years, the overall 10-year survival rate was 25%. Multivariate analysis indicated that both age, i.e., < 50 years (p = .004) and achievement of a final CR (p = .002) were significant factors for improved survival. Median survival for all patients was only 21 months and for those in final CR 30 months. These survival figures were all significantly lower than those of similarly treated patients with laryngeal or nasopharyngeal tumors, illustrating that all patients with head and neck tumors achieving a final clinical CR do not automatically have improved survival. These results emphasize the need for randomized trials, with sufficient numbers to identify optimal treatment strategies for tumors at specific sites within the head and neck region.