HEAD AND NECK CANCER
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Why has induction chemotherapy for advanced head and neck cancer become a United States community standard of practice?
Harari PM.
J Clin Oncol 1997 May;15(5):2050-5.The results of this study show that the efficacy of the most commonly prescribed treatment for patients with head and neck cancer has never been demonstrated in clinical trials. The author of the study investigated why induction chemotherapy is commonly given to patients with advanced head and neck cancer, in spite of 20 years of research demonstrating its ineffectiveness in controlling tumor growth or improving survival in these patients. Two hundred eighteen physicians from 47 U.S. states specialized in cancer treatment were asked to fill a questionnaire indicating what is their treatment of choice for patients with head and neck cancer. Induction chemotherapy with fluorouracil and cisplatin followed by radiation therapy was the most commonly used approach, and was utilized in 61% of cases. The most frequent reasons for use of this protocol were: to improve survival (56%), to maintain a spirit of multidisciplinary care (34%), to improve quality of life (29%), and to reduce occurrence of distant metastases (26%). None of the reasons reported are valid in light of the results of the last two decades of research in the field.
Lack of evidence for a role of chemotherapy in the routine management of locally advanced head and neck cancer.
Tannock IF; Browman G.
J Clin Oncol, 4(7):1121-6 1986 Jul.This article highlights that, despite several studies demonstrating high rates of tumor responses (tumor shrinkage) in patients with head and neck cancer receiving chemotherapy, this treatment does not prolong survival and is associated with significant toxicity. The authors conclude that at present, chemotherapy has no role in the management of head and neck cancer.
Surgical complications in patients with head and neck cancer receiving chemotherapy.
Corey JP, et al.
Arch Otolaryngol Head Neck Surg, 112(4):437-9 1986 Apr.The results of this study show that chemotherapy before surgery is associated with a high rate of post-operative complications in patients with head and neck cancer. Complications occurred in 70% of patients who underwent pre-operative chemotherapy, compared to 42% of those who did not receive it prior to surgery.
Current role of chemotherapy in head and neck cancer.
Tobias JS.
Drugs 1992 Mar;43(3):333-45.This article emphasizes that chemotherapy in patients with head and neck cancer has been associated with tumor shrinkage, which is usually of short duration. Since clear data on the effects of this treatment on survival are still lacking, the author concludes that its use should be discouraged outside clinical trials settings.
Final report of a phase II evaluation of paclitaxel in patients with advanced squamous cell carcinoma of the head and neck
An Eastern Cooperative Oncology Group trial (PA390).
Forastiere AA; Shank D; Neuberg D; Taylor SG 4th; DeConti RC; Adams G.
Cancer, 82(11):2270-4 1998 Jun 1.This article emphasizes that chemotherapy does not improve survival in patients with advanced head and neck cancer. Although shrinkage of tumor (tumor response) occurs in 15-30% of patients, it is not associated with improved relapse-free or overall survival. This study investigated the effects of a new anti-cancer drug, paclitaxel, on 30 patients with advanced head and neck cancer. Ninety-one percent of patients developed severe or life-threatening reduction in the number of white blood cells. Two patients died, one of sepsis, the other of myocardial infarction. Tumor response was observed in 12 patients, and was partial in 8 and complete in 4, with an average duration of response of 4.5 months. Average survival was 9.2 months. Surprisingly, the authors concluded that paclitaxel is an active agent for the management of head and neck cancers.
The chemotherapy of head and neck cancer.
de Mulder PH.
Anticancer Drugs 1999 Nov;10 Suppl 1:S33-7.This article underlines that use of chemotherapy has not shown to improve survival in patients with advanced head and neck cancer, and that regimens with multiple anticancer agents do not produce better results, than those utilizing single agent chemotherapy.
Adjuvant chemotherapy in head and neck cancer.
Stell PM, Rawson NS.
Br J Cancer 1990 May;61(5):779-87.This study reviewed 23 trials investigating the effects of adjuvant chemotherapy in the management of patients with head and neck cancer. The results of the meta-analysis showed that chemotherapy, whether administered as single agent or combination regimen, did not significantly improved survival in patients with head and neck cancer. In 4 studies chemotherapy induced tumor response in 50% of patients, but increased mortality rates by 6%. Only 3 studies evaluated treatment-related toxicity, and they found a high rate of adverse events. Treatment-related deaths were reported in 9 studies, and affected 6.5% of patients.
Meta-analyses in head and neck squamous cell carcinoma. What is the role of chemotherapy?
Bourhis J, Pignon JP.
Hematol Oncol Clin North Am 1999 Aug;13(4):769-75, vii.This article highlights that, in spite the publication of over 70 randomized trials conducted to determine whether the addition of chemotherapy to surgery improves survival in patients with head and neck cancer, there is still no conclusive evidence on the effects of this treatment. Most trials reported no effects; some reported benefits, other harm, associated with this treatment modality.
Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials.
El-Sayed S, Nelson N.
J Clin Oncol 1996 Mar;14(3):838-47.This study conducted a meta-analysis of 42 randomized trials evaluating the effects of treatment with or without chemotherapy in patients with head and neck cancer. Although a small survival advantage was observed in patients receiving chemotherapy compared to those who did not, the addition of chemotherapy resulted in a significant higher rate of toxicity. No information on quality of life was provided.
A randomized trial of adjuvant chemotherapy in head and neck cancer.
Taylor SG 4th, et al.
J Clin Oncol 1985 May;3(5):672-9.The results of this randomized study show that the addition of chemotherapy to treatment with radiation and surgery in patients with head and neck cancer does not result in improved tumor control, relapse-free or overall survival.
Adjuvant chemotherapy for advanced head and neck squamous carcinoma. Final report of the Head and Neck Contracts Program.
Cancer 1987 Aug 1;60(3):301-11.This study reports the results of a randomized trial instituted by the National Cancer Institute, conducted to assess the effects of chemotherapy in the management of patients with head and neck cancer. Four hundred sixty-two patients were enrolled. They were randomized to receive standard treatment (surgery plus radiation therapy), chemotherapy prior to standard treatment, or chemotherapy prior and following standard treatment. No significant differences in relapse-free and overall survival were observed between the three groups.
Evidence-based recommendations against neoadjuvant chemotherapy for routine management of patients with squamous cell head and neck cancer.
Browman GP.
Cancer Invest 1994;12(6):662-70.This study applied rigorous methodological standards to the evaluation of 12 randomized trials of neoadjuvant chemotherapy in patients with head and neck cancer. Survival rates of patients receiving chemotherapy in addition to standard treatment (surgery and radiotherapy) were compared to those of patients who received standard treatment only (untreated group). Seven trials detected no differences in survival between the two groups; four studies found improved survival in untreated patients and one study found improved survival in treated patients. Overall, average survival was prolonged in patients who did not receive treatment compared to those who did (20.9 months in untreated vs. 20 months in treated patients). These data indicate that chemotherapy adversely affects survival in patients with head and neck cancer.
Failure of short-course multiple drug chemotherapy to benefit patients with recurrent or metastatic head and neck cancer.
Tannock I; Sutherland D; Osoba D.
Cancer, 49(7):1358-61 1982 Apr 1.The results of this article show that combination chemotherapy in patients with advanced head and neck cancer is associated with significant toxicity and modest results. Of 52 patients treated, only 6 responded to the treatment with tumor shrinkage, but the responses were, in 5 cases, of short duration. One patient died from treatment-related toxicity, two from unknown causes, and 14 others developed serious complications.
