Targeted chemoradiation for advanced head and neck cancer: Analysis of 213patients

Background. To determine the survival results, patterns of relapse, and org an preservation effects of a targeted chemoradiation protocol for patients with advanced (stage Ill-IV) carcinoma of the head and neck. Methods. Analysis of 213 patients with stage Ill-IV squamous cell carcinoma treated at UT Memphis between June 1993 and March 1998. Treatment included weekly intra-arterial infusions of cisplatin (150 mg/m(2)/week x 4) rapidl y delivered to the tumor bulk, simultaneous intravenous thiosulfate for sys temic drug neutralization, and conventional external-beam irradiation (180- 200 cGy/fraction) to a total dose of 68-72 Gy. Results. Tumor response, toxicity, disease control above the clavicle, patt ern of relapse, and survival. There were 89 events of grade III-IV toxicity and 6 treatment-related deaths (grade V). Complete response in the primary and regional sites was obtained in 171 of 213 (80%) and 92 of 151 (61%), r espectively. The rate of clearance of regional disease after neck dissectio n was 98%. There were 51 of 195 recurrences (26%): 11 local (5.6%), 5 regio nal (2.6%), and 35 distant (17.9%). The Kaplan Meier plot projections for o verall and cancer-related 5-year survival was 38.8% and 53.6%, respectively , whereas disease control above the clavicle was 74.3%. Conclusions. We believe this chemoradiation protocol represents an effectiv e management scheme for patients with advanced head and neck cancer with a high rate of organ preservation and possibly improved survival. (C) 2000 Jo hn Wiley & Sons, Inc.