الفهرس 
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Abstract
Background: EGFr is a transmembrane glycoprotein encoded by c-erb B1 proto oncogen. It was known to be expressed in about 80 % - 100 % of head & neck cancers. - Objectives: This study was planned aiming to explore the incidence & prognostic value of EGFR expression in cases of squamous cell carcinoma of the head &neck. Also, to evaluate aggressive treatment protocols in these cases. - Patients & Methods: • EGFR status was evaluated in 54 patients of squamous cell carcinoma of head and neck: Arm I: 15 patients (Stage III-IV) who underwent radical surgery of oral cavity, larynx, maxilla and hypopharynx. Those patients received postoperative radiotherapy aiming at 5000 cGy/ 5 weeks / 25 treatment. Arm II: 13 patients (stage III-IV) who underwent radical surgery of oral cavity, larynx, maxilla and hypopharynx. Those patients received postoperative radiotherapy aiming at 5000 cGy / 5Ws / 25 treatment with platinol 20 mg/m2 weekly during the course of radiotherapy and two cycles of adjuvant chemotherapy platinol + 5 FU. Arm III: 10 patients of locally advanced (stages III-IV) non resectable non-metastatic of larynx, nasopharynx, Hypopharynx and oral cavity. they received induction chemotherapy platinol + 5FU for 2-3 cycles and radical radiotherapy. Arm IV: 11 patients of locally advanced stage III-IV non resectable, non metastatic carcinoma of larynx, nasopharynx, hypopharynx and oral cavity. They received induction chemotherapy platinol + 5FU for 2-3 cycles and radical radiotherapy (Hyperfractionation) twice daily 1-2 Gy/fraction. Arm V: Five patients of glottic carcinoma (T1-T2 N0). They received radical radiotherapy aiming at 6500 c Gy/5-6 weeks/ 33 treatment. -Results: • All the tumor tissues exhibited positive staining for EGFR: 20 cases EGFR +, 13 cases EGFR++ and 21 cases EGFR+++. • There was no statistical significant relation between EGFR expression and clinical prognostic factors. • There was highly significant statistical relation between EGFR+++ and locoregional recurrence & disease specific death. • EGFR expression and Karnofsky performance score were the most independent prognostic factors for overall survival in multivariate analysis. - Conclusions: • EGFR over expression is independent prognostic marker for higher locoregional relapse and shorter survival. • EGFR status should be evaluated before starting treatment to identify patients with EGFR over expression, who would get benefit from more aggressive treatment i.e extensive resection, combination of post operative chemoradiotherapy and altered fractionated radiotherapy .