Aggressive concurrent chemoradiotherapy for squamous cell head and neck cancer - An 8-year single-institution experience

Background: Since 1989, 105 patients with squamous head and neck cancer hav e been treated with combined chemoradiotherapy. Objective: To examine the effectiveness of using combined chemoradiotherapy on patients with squamous head and neck cancer. Design: Eight-year(1989-1997) single-institution evaluation of 105 patients . Methods: Treatment consisted of fluorouracil, 1000 mg/m(2) per day, and cis platin, 20 mg/m(2) per day, both given as continuous infusions during 4 day s beginning on day 1 and 22 of a concurrent radiotherapy course. Radiation was given in single daily fractions of 1.8 to Z Gy, to a total dose of 66 t o 72 Gy. Salvage surgery was performed for any residual or recurrent locore gional disease. Planned neck dissection was recommended for all patients wi th N2+ neck disease, irrespective of clinical response. Results: The 105-patient cohort consisted of 79 men and 26 women. The prima ry site was identified in the oral cavity in 6, oropharynx in 46, larynx in 30, and hypopharynx in 20 patients. Two patients had multiple primaries an d 1 patient had an unknown primary. There were 4 patients with stage Il, 24 with stage III, and 77 with stage IV disease. Grade 3 and 4 chemoradiother apy toxic effects included mucositis in 88% of patients, cutaneous reaction in 50%, neutropenia in 49%, thrombocytopenia in 12%, and nausea in 5%. The re were no deaths secondary to treatment. The mean weight loss was 12% of i nitial body weight. To date, primary site persistence or recurrence has occ urred in only 14 patients(13%). With a mean follow-up of 39 months, 66 pati ents (63%) are alive and free of disease. The Kaplan-Meier 4-year projected overall survival is 60% with a disease-specific survival of 74%, a distant metastasis-free survival of 84%, and an overall survival with primary site preserved of 54%. Conclusions: This chemoradiotherapy regimen, although toxic, is tolerable w ith appropriate supportive intervention. Locoregional and distant control a re likely. Primary site conservation is possible in most patients. Chemorad iotherapy appears to have an emerging role in the primary management of hea d and neck cancer.