J. Corry et al., Radiation with concurrent late chemotherapy intensification ('chemoboost')for locally advanced head and neck cancer, RADIOTH ONC, 54(2), 2000, pp. 123-127
Citations number
27
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
The aim of this study was to review our experience with a treatment regimen
that combined conventionally fractionated radiation therapy (70 Gy over 7
weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently i
n the last 2 weeks of radiation therapy in patients with previously untreat
ed advanced squamous cell cancer of the head and neck region.
Twenty-eight patients, all but two having UICC stage IV disease, were treat
ed at the Peter MacCallum Cancer Institute between November 1995 and April
1998. Planned chemotherapy consisted initially of continuous infusion at 10
mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on da
ys 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiothe
rapy. After the first 14 patients, the dose of fluorouracil was reduced to
360 mg/m(2) per day because of acute toxicity.
Twenty patients had a complete response to chemoradiation, giving a complet
e response rate of 71% (95% confidence interval (CI) 51-87%). The median fa
ilure-free survival was estimated to be 12.3 months (CI, 5.8- > 35.2 months
). The estimated cumulative incidences of the sites of first failure at 2 y
ears were 41% (CI, 22-60%) for locoregional relapse (or persistent disease)
and 16% (CI, 2-30%) for distant metastases. Altogether an estimated 25% of
patients (CI, 7-43%) developed distant metastases by 2 years, either as fi
rst or subsequent failure. The median overall survival of the whole group w
as estimated to be 23.5 months (CI, 16.5- > 36.8 months), with an estimated
50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed co
nfluent mucositis and 11 (39%) developed patchy mucositis. The median durat
ion of mucositis for these 27 patients was 1.5 months. Seventeen patients (
61%) required nutritional support for a median duration of 1.4 months. Four
teen patients (50%) had grade three skin reactions, and 12 (43%) had one or
more other significant (Grade 3) toxicities, predominantly infective. Grad
e 3 late toxicity has been observed in three patients to date (three xerost
omia, including one with severe depression), and one patient had chronic ul
ceration of the oral tongue (grade 4).
This chemoradiation regimen achieved an excellent complete response rate an
d good locoregional control at 2 years in patients with a poor initial prog
nosis. Acute toxicity was significant but manageable. The regimen offers an
alternative to surgery and postoperative radiation therapy in locally adva
nced head and neck cancer. (C) 2000 Elsevier Science Ireland Ltd. All right
s reserved.