Multidrug chemotherapy (vincristine-bleomycin-methotrexate) followed by radiotherapy in inoperable carcinomas of the head and neck A pilot study of the Radiation Therapy Oncology Group
The Radiation Therapy Oncology Group (RTOG) Pilot Study 77-08, a combination of chemotherapy with vincristine-bleomycin-methotrexate, followed by curative radiotherapy for inoperable carcinomas of the head and neck is reported. Included were patients with untreated advanced carcinomas with no distant metastasis. Patients (40) were registered for the study. Eleven of these received 1 course of the chemotherapy, and 28 were given 2 courses, with a 1-wk rest period between them. Radical curative radiotherapy was usually started 2 wk after chemotherapy. Salvage surgery was considered for persistent or recurrent tumor in the primary area, neck, or both. The level of toxicity that resulted from this combined therapy was considered acceptable. The percentage of complete response in the primary tumor was 6% with chemotherapy, 45% after irradiation, and 65% when surgery was added. The complete response (CR) in the primary tumor ranged from 54% for T-4 to 100% for T-2. By 3 yr 50% of T-2, 20% of T-3, and 13% of T-4 remained under control. The control of T and N with this therapeutic regime was 41% initially, 24% at 1 yr, 19% at 2 yr, and 16% at 3 yr. The survival at 1, 2 and 3 yr after beginning radiotherapy was 54%, 30%, and 16%, respectively. This is considered a very satisfactory result for these very advanced inoperable patients.