COMBINED RADIOCHEMOTHERAPY WITH CARBOPLATIN IN THE TREATMENT OF ADVANCED HEAD AND NECK CARCINOMAS

From 1987 to 1991, 100 evaluable patients with advanced head and neck carcinomas (T2-4, NO-3) were treated with radiotherapy and simultaneou s carboplatin. Tumors were located in the oral cavity in 33 patients, oropharynx in 8 patients, and hypopharynx in 7 patients. Four patients had a tumor of the epipharynx, 3 of the larynx, and 45 had involvemen t of two or more compartments. Radiotherapy was performed in a fractio nation of 5 x 2 Gy/week up to a dose of 50 Gy. Carboplatin was adminis tered in a dose of 60 or 70 mg/m(2) from days 1-5 and 29-33. After a 2 -week interval, tumor involution was evaluated and a decision was made on the patients' operability. In cases of inoperability, radiotherapy was continued up to a dose of 70-74 Gy. Thirty patients underwent sur gery after 50 Gy. Eight patients showed a histologically complete remi ssion (CR), 7 showed microscopic residual tumor, and 15 showed macrosc opic tumor. Seventy patients were treated with radiotherapy and concom itant carboplatin only. Thirty-nine of them achieved a CR and 30 a par tial remission (PR). The residual tumor was operable in 8 of the latte r patients. Only a minor response was achieved in the remaining patien t. At the end of the treatment 77 patients achieved a CR with this com bined modality. From 1990 to 1992, 20 patients with locally advanced h ead and neck carcinomas underwent hyperfractionated accelerated radiot herapy (2 x 1.6 Gy/day, 5 days per week: total dose, 64-67.2 Gy) and s imultaneous intravenous carboplatin (60 mg/m(2), days 1-5 and 29-33) i n a pilot study. Fifteen patients had T4 and 5 had T3 tumors. Six week s after the end of treatment, 16 patients (80%) had CR, and PR was see n in the other 4 patients (20%). Overall and disease-free survival at 1 year was 82 and 81%, respectively. Although acute side effects were more pronounced compared with conventional irradiation, this treatment regimen is feasible and the initial CR rate of 80% is encouraging. Be cause of the results achieved with hyperfractionated accelerated radio therapy, we initiated a multicenter randomized study in November 1991. Patients with advanced head and neck carcinomas are either randomized for conventional radiotherapy with carboplatin or hyerfractionated ac celerated irradiation with carboplatin. Results will be forthcoming.