CONCOMITANT RADIOCHEMOTHERAPY (CDDP 4-6 M G M2/D) IN LOCALLY ADVANCEDHEAD AND NECK-CANCER/

In order to enhance radiation effects in the treatment of unresectable Head and Neck squamous cell carcinoma, we initiated a phase I-II stud y in February 1991 with concomitant radiation and cisplatin in the tre atment of unresectable Head and Neck squamous cell carcinoma. The firs t patient was treated in a palliative intend for a cervical recurrence (cutaneous metastatic lymphangitis) of laryngeal cancer. The seven ot her patients had a Stage IV MO, previously untreated, oropharyngeal ca rcinoma. Standard external radiation was carried out up to a total dos e of 60 Gy/6 weeks (7 Me V electron beam) for the 1st patient and 72 G y/8 weeks (Co-60 beam) for the 7 other patients. Cisplatin was given d uring the entire radiation treatment, by continuous infusion, 5 days a week, at doses of 4 mg/m2/d for the 1st patient, 5 mg/m2/d for the tw o following patients and 6 mg/m2/d for the last five patients. One pat ient with a poor initial performance status (three in the WHO scale) s topped his treatment on the 6th week due to a grade 3 mucositis with d eglutition pneumonia. He died 2 months later with progressive carcinom a. For one other patient, treatment was discontinued for 1 week after 48 Gy, due to a grade 3 mucositis. The other patients completed the pl anned protocol without any interruption. Mucositis (grade 3 in two cas es, grade 2 in four cases), dermitis (grade 3 in two cases, grade 2 in four cases) and neutropenia (grade 2 in two cases) were the most freq uent acute toxicity. Of the seven patients treated with a curative int end, six are free of disease at 6 to 28 months after completion of tre atment. A pharmacokinetic study showed a total platinum accumulation. The mean value at the end of treatment reached 1157 ng/ml. Only one pa tient experienced an accumulation of the ultrafilterable platinum (137 ng/ml at the end of treatment).