CONCOMITANT CISPLATIN 5-FU INFUSION AND RADIOTHERAPY IN ADVANCED HEADAND NECK-CANCER - 8-YEAR ANALYSIS OF RESULTS/

Background. The purpose of this study was to analyze long-term follow- up of a single institution's experience with a regimen of concomitant cisplatin/fluorouracil (5-FU) infusion and radiation given every other week. This analysis was stimulated by results of a randomized trial s howing superiority for this regimen over induction cisplatin/5-FU chem otherapy followed by radiotherapy, especially in regional disease cont rol. Methods. All patients with stage III/IV disease who were referred by surgeons for nonoperative therapy and had a follow-up of at least 2 years were included. Concomitant chemoradiotherapy was administered days 1-5 of a 2-week treatment cycle, for a total of 7 cycles, with ci splatin 60 mg/m(2) day 1, 5-FU 800 mg/m(2) given over 24 hours days 1- 5, and radiation 2 Gy days 1-5. Results. Seventy-eight patients with s tage III (n = 16) or IV (n = 62) were treated and followed for a media n of 8 years. Six patients died during treatment, of aspiration pneumo nia, sudden death, gastrointestinal bleeding, and stroke. When assesse d 6 weeks after the end of treatment, 45 patients (63%) had no clinica l evidence of disease, whereas 27 (37%) still had some persistent abno rmality. However, 17 of these ''partial responders'' have not recurred . In all, 24 patients (31%) have recurred or progressed, 13 at the pri mary site, 5 after 3 years. None of 16 stage III and 24 (39%) of 62 st age IV patients ever progressed. Tongue and glottic larynx did best, w ith only 1 of 22 patients ever failing (none locally). Supraglottic an d oral cavity cancers other than tongue had the worst failure rates. N ineteen patients (24%) died of other causes (DOC), tumor-free. Patient s who DOC correlated strongly with T stage (p < .002) but not with N s tage or with AJC stage. The 5-year progression-free survival was 60% ( confidence interval [CI] = 49% to 72%), and overall survival was 43% ( CI = 33% to 56%). Conclusions. Disease control for this advanced head and neck cancer population was excellent. This regimen was especially effective in advanced tongue and glottic cancers and all stage III dis ease sites. Advanced supraglottic and hypopharynx cancers are problema tic. These, and especially T4 lesions, are associated with high DOC ra tes, possibly in part related to swallowing malfunction. Nevertheless, the long-term survival without surgical intervention was high with th is regimen. (C) 1997 John Wiley & Sons, Inc.