CISPLATIN AND CONTINUOUS-INFUSION OF FLUOROURACIL FOLLOWED BY RADIATION AND WEEKLY CARBOPLATIN IN THE TREATMENT OF LOCALLY ADVANCED HEAD AND NECK-CANCER - A HELLENIC COOPERATIVE ONCOLOGY GROUP-STUDY

Induction chemotherapy followed by radiation has been extensively stud ied in an effort to improve local control and possibly overall surviva l of patients with locally advanced head and neck cancer. From June 19 89 until May 1991, 39 patients with locally advanced squamous cell car cinoma of the head and neck (SCCHN) were treated with 3 cycles of indu ction chemotherapy, consisting of cisplatin (100 mg/m(2) d 1) and fluo rouracil (1000 mg/m(2) d 2-6) followed by radiation potentiated by wee kly administration of carboplatin (60 mg/m(2)). Surgery was performed in selected patients with residual disease after the combined modality approach. Four cycles of adjuvant chemotherapy with carboplatin (325 mg/m(2)) and bleomycin (15 u) were administered in those patients who demonstrated a partial response after locoregional treatment. There we re 36 men and 3 women with a median age of 56 (range 39-74) years and Karnofsky performance status of 70 (range 60-100). The primary site of the tumor was nasopharynx (8), oropharynx (8), hypopharynx (3), oral cavity (4), larynx (13), paranasal sinus (2), and salivary glands (1). Thirty-two (82%) patients presented with stage IV disease. After the completion of induction chemotherapy, 14 (36%, 95% CI 21-53%) patients achieved a complete response (CR). This CR rate was increased to 56% (95% CI, 42-74%) after locoregional treatment. Main toxicities include d nausea/vomiting (56%), leukopenia (40%), anemia (30%), thrombocytope nia (10%), stomatitis (28%), diarrhea (17%), and alopecia (12%). Media n relapse-free survival was 18 (1-50) months, median time to progressi on was 13 (0.3-58.5) months, and median survival 19 (0.3-59) months. I nduction chemotherapy with cisplatin and fluorouracil followed by radi ation potentiated with carboplatin is feasible. However, this combined modality approach, as applied in the present study, does not appear t o yield superior results than those reported with chemotherapy followe d by radiation alone.