The recent article on the value of surgery after induction chemotherapy in advanced head and neck cancer is a valuable contribution to the medical literature.1 We agree with many of the comments and conclusions of the study about the need for surgery if possible.
However, from a scientific and radiation oncology perspective, there are some significant concerns in the article. From a patient base of 317, only 130 responders are analyzed. The article is a nonrandomized retrospective study. The group receiving chemotherapy, surgery, and postoperative radiation had a significantly higher proportion of oral cavity and hypopharynx tumors, while the group receiving chemotherapy and radiation was weighted with oropharyngeal lesions. Similarly, 75% of patients in the chemotherapy-surgery-radiation arm received combination chemotherapy, while 70% in the chemotherapy-radiation arm received single-agent methotrexate.
We agree with the advice not to modify local treatment (surgery or radiation) in chemotherapy responders. However, the radiation dose
Lawrence G, Bansal P. Combined Modality Treatment of Advanced Head and Neck Cancer. Arch Otolaryngol Head Neck Surg. 1997;123(1):116. doi:10.1001/archotol.1997.01900010126023