RECURRENCE PATTERNS WITH CONCURRENT PLATINUM-BASED CHEMOTHERAPY AND ACCELERATED HYPERFRACTIONATED RADIOTHERAPY IN STAGE-III AND STAGE-IV HEAD AND NECK-CANCER PATIENTS

BACKGROUND: Stage III and IV squamous cell cancers of the head and nec k are often unresectable at presentation and are associated with poor disease-free and overall survival rates. A phase II study using concur rent cisplatin and radiotherapy in advanced head and neck cancer indic ated impressive local-regional control and survival with organ preserv ation. METHODS: A multicentered phase II study was undertaken consisti ng of 1.8 Gy fraction radiotherapy for 2 weeks followed by 1.2 Gy BID hyperfractionation to 46.8 Gy. Continuous infusion cisplatin 20 mg/m(2 ) was given on days 1 through 4 and 22 through 25. Biopsy of the prima ry tumor was done at this point, and patients with clinical and pathol ogic complete response continued with hyperfractionated radiotherapy t o 75.6 Gy plus simultaneous carboplatin 25 mg/m(2) BID for 12 consecut ive days. Residual disease at 46.8 Gy required curative surgery. RESUL TS: Seventy-four patients entered the study, and 73 completed their tr eatment, Twenty were stage III and 54 were stage IV. Fifty patients ha d involved regional lymph nodes. Treatment was well tolerated with onl y one grade IV hematologic toxicity. At 46.8 Gy, biopsy revealed a com plete response in 75% of the primary sites and 47% of the nodes. Only 12 patients required resection of the primary lesion. At 4 years (medi an follow-up is 26 months), 29 patients have recurred. CONCLUSIONS: Ac celerated hyperfractionated radiotherapy with concurrent chemotherapy in stage III and IV head and neck cancer yields excellent local-region al control with organ preservation. This protocol is intensive, and so me patients have distant failures. (C) 1997 by Excerpta Medica, Inc.