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