COMBINED CONCOMITANT BOOST RADIOTHERAPY AND CHEMOTHERAPY IN STAGE III-IV HEAD AND NECK CARCINOMAS - A COMPARISON OF TOXICITY AND TREATMENT RESULTS WITH THOSE OBSERVED AFTER RADIOTHERAPY ALONE
As. Allal et al., COMBINED CONCOMITANT BOOST RADIOTHERAPY AND CHEMOTHERAPY IN STAGE III-IV HEAD AND NECK CARCINOMAS - A COMPARISON OF TOXICITY AND TREATMENT RESULTS WITH THOSE OBSERVED AFTER RADIOTHERAPY ALONE, Annals of oncology, 8(7), 1997, pp. 681-684
Background: Alteration of radiation therapy (RT) fractionation and the
combination of chemotherapy (CT) with RT represent two predominant fi
elds of current research in the treatment of head and neck carcinomas.
To assess the potential integration of these two fields, a retrospect
ive comparison of toxicity and treatment outcome was carried out in st
age III-IV patients treated with a concomitant boost RT schedule with
or without CT. Patients and methods: Fifty-two patients were treated b
y RT alone and 35 by RT and CT. In the RT group, there were significan
tly fewer T3-4 tumors (56% vs. 88%, P = 0.002) and higher proportion o
f planned neck dissections (35% vs. 14%, P = 0.047). The planned total
dose was 69.9 Gy delivered over 5.5 weeks. In 10 cases CT was given b
efore RT and in 25 concomitantly with RT, either alone or with neoadju
vant and/ or adjuvant CT. All patients but two had cisplatin-based (CD
DP, 100 mg/m(2)) CT, associated in 28 patients with 5-fluorouracil (5-
FU, 1000 mg/m(2)/24 h x 5). The median follow-up for the surviving pat
ients was 21 and 31 months for the RT and RT-CT groups respectively. R
esults: Grade 3-4 acute toxicity (RTOG) was observed in 73% and 86% of
patients, and grade 3 dysphagia in 31% and 57% (P = 0.02) respectivel
y in the RT and RT-CT groups. The rates of grade 3-4 late complication
s were similar in the two groups (5% vs. 12%). At three years, actuari
al loco-regional control (LRC) was 57% and 66% (P = 0.66) and overall
survival was 56% and 47% (P = 0.99) in the RT and RT-CT groups respect
ively. Conclusions: While acute toxicity was higher compared with RT a
lone, this accelerated RT schedule was feasible in association with 5-
FU/CDDP, even administered concomitantly. Despite the significant prop
ortion of more advanced disease in the RT-CT group, LRC was similar to
that obtained by RT alone. Combinations of concomitant boost RT and c
hemotherapy merit further investigation in prospective trials.