Combination therapy protocol for stage III or IV carcinoma of the oral cavity, oropharynx and hypopharynx.

Combined therapy programs have improved recurrent and nodal metastatic rates but have not controlled distant metastases. A pilot study undertaken at Ohio State University evaluated the feasibility of adding chemotherapy to a combined modality regimen. The first phase determined that the toxicity of a four-drug combination chemotherapy yielded a favorable risk/benefit ratio and justified its inclusion in a protocol for untreated cancers. The second phase evaluated chemotherapy followed by surgery and postoperative irradiaation for untreated Stage III and IV epidermoid carcinoma of the oral cavity, oropharynx or hypopharynx. The overall chemotherapy response rate is 88% (22/25) with 6 complete and 16 partial responses. Evaluation of pathology specimens revealed 7 of 14 primary sites and 4 of 15 neck specimens had no histologic evidence of carcinoma. In the 10 patients who received all 3 modalities, 9 are free of disease (6 to 17 mo. follow-up).