Locally advanced (stage III and IV) head and neck cancer: Westmead Hospital experience.

Two hundred and fifty-one patients with Stage III and IV (UICC staging system) squamous cell cancers of the oral cavity, oropharynx, hypopharynx and larynx were assessed between January 1980 and December 1988 at Westmead Hospital. Of these, 50 patients received palliative treatment or were not treated and the remaining 201 patients received treatment with curative intent by various combinations of radiotherapy, surgery and chemotherapy. Thirty-nine operable cases were entered into a multimodality protocol initiated in April 1985, which consisted of induction chemotherapy (cisplatin 100 mg/m2 i.v. day 1, 5-fluorouracil 1000 mg/m2 per 24 h i.v. days 1-5, q3w x 2) followed by surgery and postoperative radiotherapy. The median follow-up for all 251 patients was 57 months. Actuarial 3-year survival rate for all 201 patients receiving radical treatment was 48% (Stage III 66%, Stage IV 36%; P less than 0.001). Overall actuarial local and nodal control rates at 3 years were 67% and 69%. Thirty-two of 201 patients (16%) developed distant metastases at a median time of 11 months. Twenty-one patients (10%) had a previous or subsequent second primary cancer. In the group of 39 protocol patients, overall actuarial survival, local and nodal control rates are 68%, 77% and 73% at 3 years. A group of 22 'protocol' patients was compared with a group of 22 patients treated prior to commencement of the protocol, matched as closely as possible on the basis of site, stage, age, sex and ECOG status.(ABSTRACT TRUNCATED AT 250 WORDS)