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In Reply.—Robbins and Storniolo have raised an interesting question that we had not considered in comparing the outcomes of these two groups of patients.
It has been our impression from years of attendance at tumor boards and working with head and neck surgeons that the criteria used to evaluate patients for surgery are much the same as those used to evaluate patients for chemotherapy. Thus, patients with stages III and IV head and neck cancer, who are considered medically able to undergo ablative head and neck surgery on the basis of their performance status, cardiac condition, pulmonary function, and other illnesses, are also physiologic candidates for chemotherapy. The exception to that general statement are patients with renal impairment who are unable to receive platinol.
At the Veterans Affairs Medical Center (Buffalo, NY) where the majority of patients were treated, all patients with head and neck cancer are presented at