A phase II randomized trial comparing neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in advanced squamous cell carcinoma of the pharynx or larynx

Abstract

BackgroundTo clarify the effect of induction chemotherapy (ICT) in patients with advanced pharyngeal and laryngeal squamous cell carcinoma (PLSCC) treated with concurrent chemoradiotherapy (CCRT).MethodsPatients with treatment-naïve nonmetastatic advanced PLSCC were stratified according to disease stage (III or IV) and resectability before being randomized to either a ICT/CCRT or CCRT arm. A cisplatin/tegafur-uracil/leucovorin regimen was administered during ICT and CCRT. The primary end point was overall survival (OS).ResultsWe enrolled 151 patients during December 2006 to February 2011. The median follow-up of surviving patients was 54.5 months. The ICT/CCRT arm included more patients with hypopharynx cancer (57.1% vs 40.5%, p = 0.09) and N2 or N3 diseases (85.7% vs 74.4%, p = 0.02). In the ICT/CCRT and CCRT arms, the 5-year OS was 48.1% and 53.2% (p = 0.45); progression-free survival (PFS) was 31.8% and 55.6% (p = 0.015); and locoregional control (LRC) was 37.7% and 56.2% (p = 0.026), respectively. The adverse events and compliance to radiotherapy were similar. However, the proportion of patients receiving a total dose of cisplatin during CCRT <150 mg/m2 was higher in the ICT/CCRT arm (46.8% vs 16.2%; p = 0.000) and independently predicted poorer PFS and LRC in multivariate analysis.ConclusionOS did not vary between the ICT/CCRT and CCRT arms. However, poorer compliance to CCRT and inferior LRC and PFS were observed in the ICT/CCRT arm. Optimizing the therapeutic ratio in both ICT and CCRT settings are necessary for developing a sequential strategy for patients with advanced-stage PLSCC.

A comparison of the MNA-SF, MUST, and NRS-2002 nutritional tools in predicting treatment incompletion of concurrent chemoradiotherapy in patients with head and neck cancer

“…All eligible patients received intensity-modulated or arc technique radiotherapy at a conventional fractionated daily dose of 200 cGy for 5 consecutive days per week, with a total prescribed radiotherapy dose of 7,000-7,400 cGy over 7 weeks. The chemotherapy regimens, including cisplatin (40 mg/m 2 every week or 100 mg/m 2 every 3 weeks), PF regimen (cisplatin 60 mg/m 2 on day 1 plus continuous infusion of 5-uorouracil 800 mg/m 2 on days 1-5, every 2 weeks) [14], and PUL regimen (cisplatin 50 mg/m 2 on day 1, tegafur-uracil [TTY Biopharm Co. Ltd, Taipei, Taiwan] 300 mg/m 2 /day, and oral leucovorin 60 mg/day on days 1-14, every 2 weeks) [15]were administered concurrently with radiotherapy according to the treatment guidelines at our institution.…”

The Integration of a Three-Dimensional Spheroid Cell Culture Operation in a Circulating Tumor Cell (CTC) Isolation and Purification Process: A Preliminary Study of the Clinical Significance and Prognostic Role of the CTCs Isolated from the Blood Samples of Head and Neck Cancer Patients

“…Other treatments included methotrexate (40 mg/m 2 or a fixed weekly dose of 50 mg), bleomycin (15 mg weekly), and oral tegafur-uracil (300 mg/m 2 /day; TTY Biopharm Co., Ltd., Taipei, Taiwan). Chemotherapy regimens for chemoradiotherapy mainly included cisplatin (50–75 mg/m 2 biweekly to triweekly) and 5-fluorouracil (700–1000 mg/m 2 /day as a continuous infusion during days 1–4 every 28 days) or oral tegafur-uracil (300 mg/m 2 /day) every day in a 28-day cycle [26].…”

Saliva biomarkers in neurological disorders: A “spitting image” of brain health?

“…Huang et al. [29] add to the debate in a trial of patients with advanced pharyngeal and laryngeal squamous cell carcinoma, whereby patients were randomized to receive either induction chemotherapy before concurrent chemoradiotherapy or concurrent chemoradiotherapy alone. Their study reveals no benefit of induction chemotherapy for overall survival rate, arguing against its inclusion in standard care pathways.…”