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January 1997

Combined Modality Treatment of Advanced Head and Neck Cancer

Author Affiliations

Stoneboro, Pa

Arch Otolaryngol Head Neck Surg. 1997;123(1):116. doi:10.1001/archotol.1997.01900010126023

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

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