Alternating and concurrent chemotherapy and radiotherapy for unresectable head and neck carcinoma

Abstract

Between 1987 and 1989, 12 patients with advanced unresectable head and neck carcinoma were entered on a regimen of alternating and concurrent chemotherapy and radiotherapy. During the initial phase, cisplatin (50 mg/m2/day X 3 days) was administered 1 week and alternated with 160 cGy TID radiation week 3. This alternating schedule was repeated once for a total dose of 300 mg/m2 cisplatin and a total radiation dose of 4,800 cGy. Week 9, concurrent cisplatin (20 mg/m2/day x 5 days) was administered with 200 cGy BID radiation to boost ports. In spite of the alternating schedule, acute toxicity from 160 cGy TID was severe and delays secondary to mucositis increased the average duration of therapy to 11 weeks. Unexpected chronic toxicity included 2 of 12 patients with swallowing difficulty due to a sensory neuropathy which was likely a combined modality effect. This had not been reported in previous combined modality studies. A complete response was achieved in 5 of 12 patients and a partial response in 7 of 12 patients. Overall median survival was 17 months. Although the combination of cisplatin and accelerated radiation given in the above dose schedule induced a complete or partial response in all patients, severe toxicity and lack of survival benefit discourage further use of this regimen.