To the Editor.—The results presented by Spaulding et al1 are rather intriguing. By comparing two groups of patients, each with resectable stages III and IV disease, treated differently (induction chemotherapy followed by standard care vs standard care), the authors report a significant difference in the median disease-free survival and 2-year disease-free survival in favor of the chemotherapy group. Only 8.5% of the patients who were treated in the chemotherapy arm required postoperative radiotherapy, whereas 42% of the patients treated by standard care received radiation therapy based on the same criteria.
Spaulding et al1 conclude that induction chemotherapy, in their hands, had a beneficial effect: overall survival was better and the use of postoperative radiotherapy was diminished. They suggest the key factor for this better outcome lies in the design of the study, ie, the surgical approach was not changed by the response to chemotherapy. While this conclusion
ROBBINS KT, STORNIOLO AM. Surgery vs Chemotherapy. Arch Otolaryngol Head Neck Surg. 1992;118(12):1365–1366. doi:10.1001/archotol.1992.01880120091017
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