Combined modality treatment of head and neck cancer with cisplatin, bleomycin, methotrexate‐leucovorin chemotherapy

The multidisciplinary treatment results of 114 patients with advanced, untreated Stage III and IV squamous cell carcinoma of the head and neck region are reported. Induction chemotherapy with two cycles of cisplatin 20 mg/m²/day intravenous bolus days 1 through 5, bleomycin 10 mg/m²/day as a continuous infusion days 3 through 7, and methotrexate 200 mg/m² intravenous bolus on days 15 and 22 with leucovorin rescue was utilized before definitive surgery and/or radiation therapy. The total response rate was 78% with 30 (26%) patients achieving complete response and 59 (52%) patients achieving partial response. Patient age, performance status, histologic grade of tumor, and tumor site did not predict response to chemotherapy. Induction chemotherapy was well tolerated with myelosup‐pression and nephrotoxicity being dose‐limiting in a few patients. The toxicity of subsequent local treatment with surgery and/or radiation is reported with an analysis of local treatment failures. A strong correlation was noted between local control of tumor and postchemotherapy tumor size before local treatment.