Journal of Clinical Oncology, Vol 15, 2050-2055, Copyright © 1997 by American Society of Clinical Oncology
Why has induction chemotherapy for advanced head and neck cancer become a United States community standard of practice?
PM Harari
Department of Human Oncology, University of Wisconsin School of Medicine, Madison 53792-0600, USA. harari@humonc.wisc.edu
PURPOSE: Induction chemotherapy for advanced head and neck (H&N) cancer
has been studied in clinical trials for more than two decades without clear
demonstration of benefit for locoregional tumor control or overall patient
survival. Nonetheless, its use has become a common community standard of
practice in the United States (US). This report examines some of the
factors that may have contributed to this phenomenon. MATERIALS AND
METHODS: A mail survey was conducted of 300 US community cancer specialists
(equally divided among otolaryngologists, radiation oncologists, and
medical oncologists) to solicit their most frequent therapy approach for
patients with locoregionally advanced, nonmetastatic H&N cancer. The
rationale for selection of treatment strategy was identified by each
respondent. RESULTS: Two hundred eighteen physicians (73%) completed and
returned the survey, representing 47 US states. The single most common
treatment approach reported for patients with locoregionally advanced
H&N cancer was that of sequential chemoradiation (61%), specifically,
induction chemotherapy with fluorouracil (5-FU)/cisplatin followed by
radiation therapy. Four percent of respondents indicated that induction
chemotherapy was administered within the context of a controlled clinical
trial, whereas 96% indicated that therapy was administered off study. The
primary objectives cited by respondents for the use of induction
chemotherapy included the desire to improve locoregional tumor control
(67%), to improve overall survival (56%), to maintain a spirit of
multidisciplinary care (34%), to improve quality of life (29%), and to
decrease distant metastases (26%). CONCLUSION: Review of the published
trials between 1970 and 1995 and of the published meta- analyses show no
clear evidence for an improvement in locoregional tumor control or survival
for H&N cancer patients treated with 5- FU/cisplatin induction
chemotherapy regimens. Nonetheless, this induction chemotherapy approach
for advanced H&N cancer patients has become a dominant community
practice in the US. Factors that may have contributed to this paradox are
reviewed.
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