INDUCTION CHEMOTHERAPY FOLLOWED BY SIMULTANEOUS HYPERFRACTIONATED RADIOCHEMOTHERAPY IN ADVANCED HEAD AND NECK-CANCER - A PILOT-STUDY

Purpose: To evaluate the feasibility of induction chemotherapy followe d by concomitant chemotherapy and hyperfractionated irradiation in loc ally advanced, inoperable head and neck cancer. Methods: A pilot study was undertaken comprising 3 cycles of cisplatinum (100 mg/m(2), day 1 ) and 5-fluorouracil (1000 mg/m(2) in continuous intravenous infusion over the first 120 h) followed by bifractionated radiotherapy applied to tumor/involved lymph nodes up to the dose of 74.4 Gy given in 2 fra ctions of 1.2 Gy daily for 5 days a week combined with concomitant wee kly cisplatinum infusion (50 mg/m(2)). Results: Six patients were enro lled in the study. All of them completed the protocol therapy. Severe mucositis and myelotoxicity were the most common acute side effects ob served in all and in 5 of the patients, respectively. Acute toxicity r equired interruption of concomitant chemotherapy in 5 cases and in 2 i nterruption of radiotherapy was necessary. Opioid analgesic parenteral therapy was administered in 4 patients. Three of them had to be hospi talized. One patient experienced cerebral stroke 1 day after the compl etion of therapy and died 7 days later. Due to high acute toxicity, pa tient accrual was terminated after 6 patients. At the mean follow-up o f 17 months, 4 patients are alive, 3 of them are free of disease and i n 1 local progression has been diagnosed. Conclusions: High acute toxi city of induction cisplatinum and 5-fluorouracil followed by concomita nt cisplatinum and hyperfractionated irradiation calls for less toxic treatment schedules in locally advanced inoperable head and neck cance r.