Combination chemotherapy as the first line in the management of locally advanced epidermoid carcinoma of the head and neck region in Nigerians.

Of cancer patients in Nigeria, 92% report at a late stage before treatment. Those with tumours of the head and neck region in particular, pose serious problems with management. Their advanced disease means that they are often inoperable and results of treatment by radiation are poor because the dose is limited to what the tissues can tolerate and also because the larger the tumour volume involved, the less the amount of radiation dose possible, so the response is poor. The problem is made worse by inadequate radiotherapy facilities. At the time of the study only one moderately equipped radiotherapy centre served the whole of Nigeria (with a population of 100 million) and neighbouring Ghana, Sierra-Leone and the Cameroons. There is usually a patient waiting list of about 3-4 months at any time, thus making prompt treatment impossible. These local problems and the search for an alternative approach led to this prospective study, which took place between 1980 and 1984. Two hundred and five adult patients with histologically proven, and locally advanced, epidermoid carcinoma in the head and neck region were given combination chemotherapy with Vincristine, Bleomycin and Methotrexate as the first line of management. There was a tumour regression rate of 68% (complete + partial), such that further treatment with surgery, radiotherapy, or a combination of both was then possible.