Chemotherapy of head and neck cancer

Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity

The relationship between the mode of tumor invasion in the tumor-host borderline and the frequency of regional lymph node metastasis was investigated in squamous cell carcinoma of the oral cavity. Cases with grades 1-3 mode of invasion classified by modified Jacobsson criteria showed a low frequency of metastasis (10/72, 13.9%), while those cases with grade 4 mode of invasion, which consisted of grade 4C (cord-like type) and grade 4D (diffuse type) showed a high frequency of metastasis (4C:11/18,61.1%; 4D :9/12,75.0%; total 20/30,66.7%). Moreover, the number of metastatic nodes in each case of mode of invasion ranged from 1 to 3 in grades 1-3, from 1 to 5 in grade 4C, and from 1 to 7 in grade 4D . The presence of metastasis indicated a poorer prognosis than did the absence of the mode of invasion in each grade, especially in grades 4C and 4D .

Sequential chemotherapy and radiotherapy in advanced head and neck cancer

Eighty-six previously untreated patients with advanced squamous-cell carcinoma of the head and neck were entered into a prospective randomised controlled trial to evaluate whether the addition of a kinetically based chemotherapy regimen before and after radiotherapy would improve survival compared with radiotherapy alone. Survival at 30 months showed there was no evidence that the addition of chemotherapy to radiotherapy improved survival and that the chance of obtaining a significant result in favour of adjuvant chemotherapy was remote. We make a strong plea that all chemotherapy regimens for the treatment of squamous-cell carcinoma of the head and neck regions should be subjected to controlled prospective trials before they are widely adopted.