Use of restaging primary site biopsy to optimize selection of primary therapy in high stage (III/IV) squamous cancer

6042 Background: A consecutive series of neoadjuvant protocols has focused on restaging re-biopsy to select therapy of Stage III/IV squamous cancer since 1995. Patients with positive restaging biopsy have subsequent resection whereas those having a negative re-biopsy have completion chemo- radiation therapy of primary site to total dose 68–72cGy. We are currently reporting the benefit of giving induction chemotherapy prior to chemoradiation. Methods: Initial protocols (H&N 53& 67) utilized concurrent preoperative Paclitaxel (P) (60mg/M² or 40mg/M2) + Carboplatin (AUC) + RT (45G) 67(64 evaluable pts). Subsequent studies (H&N79) utilized induction chemo (P 135mg/M², C (2AUC) weekly x 6 followed by chemoradiation therapy P 40 C (1AUC) + 45 Gy (H&N79) 32 pts (13 operable). Results: Protocols, 53 & 67 induced a complete pathologic response in 70% vs. a 52% clinically determined CR permitting completion radiation with primary site preservation. Neck dissection (ND) revealed persistent disease in 37% confirming ...