Preoperative chemotherapy-sensitized radiation therapy for cervical metastases in head and neck cancer

Objective: To determine the efficacy of concurrent preoperative cisplatin c hemotherapy and radiotherapy (CT/RT) for patients with advanced head and ne ck cancer and cervical metastatic disease. Design: Retrospective analysis. Setting: University hospitals. Patients: Eighty-eight patients with operable stage III and IV squamous cel l carcinoma of the head and neck and palpable cervical lymphogenous metasta ses received preoperative concurrent CT/RT followed by planned neck dissect ion. Interventions: All patients undergoing CT/RT received concomitant continuou s infusions of cisplatin (20 mg/m(2)) on days 1 to 4 and 22 to 25 of CT/RT. Thirty-nine patients underwent single-fraction (1.8-Gy) radiotherapy to 45 .0 Gy, and 49 patients received 10 single-fraction (1.8-Gy) treatments, whi ch were hy perfractionated (1.2-Gy twice a day) to 46.8 Gy. Main Outcome Measures: The 71 patients for whom complete post-CT/RT data we re available were evaluated: for clinical response in addition to survival. Histologic complete response (HCR) was confirmed from planned neck dissect ion specimens (n = 48) after clinical complete response (CCR) from initial CT/RT. Kaplan-Meier statistical analysis for disease-specific survival and overall survival was performed on all 88 patients who received CT/RT. Resul ts: A CCR and an HCR were noted in 78% (18/23) and 59% (10/17) of patients with N1 lesions, respectively, land in 60% (29/48) and 45% (14/31) of patie nts with: N2-3 lesions, respectively. The percentage of patients with CCR w ho also had HCR was 67% (10/15) for patients with N1 lesions and 54% (14/26 ) for patients with N2-3 lesions. With a median follow-up of 18.5 months, t he Kaplan-Meier disease-specific survival rate at 54 months (n = 88) was 70 % (21/30) for patients with N1 lesions, 60% (24/40) for patients with N2 le sions, and 39% (7/18) for patients with N3 lesions. The overall survival an d disease-specific survival rates at 5 years for all nodal groups combined were 36% (32/88) and 59% (52/88), respectively. Conclusions: A CCR to CT/RT was achieved in nearly two thirds of patients w ith head and neck cervical lymphogenous metastases, independent of nodal tu mor load. Most patients (59% [24/41]) with CCR were pathologically tumor fr ee before neck dissection.