Preoperative simultaneously administered cis‐platinum plus radiation therapy for advanced squamous cell carcinoma of the head and neck

Abstract

Synchronously administered cis-platinum (cis-DDP) and radiation therapy have been used to treat unresectable squamous cell carcinomas of the head and neck. The purpose of this study was to evaluate the efficacy and tolerance of preoperative adjuvant cis-DDP plus radiation therapy in operable stage III and IV head and neck cancers. Radiation therapy (4,500 rad) was delivered in 180-rad daily fractions. Cis-DDP (20 mg/M2) was given before radiotherapy on days 1-4 and 21-24. Eighteen patients began therapy; 16 completed the combined regimen. Toxicity included stomatitis and WBC below 2,500/mm3. One patient died from therapy of a cerebrovascular accident. Sixteen patients (89%) achieved a complete or partial response to therapy. Complete responses were observed in 13 of 18 primary tumors (72%), and in all three patients with cervical lymphadenopathy. Complete responses were noted for lesions of the nasopharynx, oral cavity, pharynx, hypopharynx, and larynx, for all histologic grades of squamous cell carcinoma. Twelve patients underwent curative surgery. Site-related morbidity occurred in two patients (15%) and a third patient developed postoperative pneumonia. Five of 10 resected primary tumors with preoperative complete responses were pathologically negative for tumor. Concurrent bolus cis-DDP and radiation therapy are well-tolerated and result in impressive tumor reduction. Morbidity after subsequent curative surgery is low, and histologic complete responses are frequent.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma

“… 12 Although such synergistic effects have been investigated for various chemotherapy agents such as hydroxyurea, 13 misonidazole, 14 mitomycin C, 15 and 5‐fluorouracil (5‐FU), 16,17 it is the platinum‐based compounds which have been widely studied and have met with the greatest success. 5,8,12,18,19 Conventional protocols adhere to the intravenous route of chemotherapy, but targeted intra‐arterial administration has the advantage of allowing higher doses to reach the tumor bed with minimal potential for the occurrence of systemic toxicity. 20 …”

Concurrent chemoradiotherapy with weekly paclitaxel and carboplatin for locally advanced head and neck cancer: Long‐term follow‐up of a Brown University Oncology Group Phase II Study (HN‐53)

“…1 In an effort to improve outcomes, a number of concurrent chemoradiotherapy schedules have been investigated. Trials evaluating concurrent chemoradiotherapy have utilized radiosensitizing agents, such as hydroxyurea, 2 cisplatin, [3][4][5] and carboplatin. 6 Phase II studies from the Radiation Therapy Oncology Group (RTOG) and the Eastern Cooperative Oncology Group (ECOG) utilizing high-dose cisplatin regimens showed promising response and survival rates.…”

Combining taxanes with radiation for solid tumors

“…Concurrent chemotherapy and radiation therapy trials have demonstrated a benefit to the combined synergism shown by a variety of radiosensitive agents such as hydroxyurea [34], misonidazole [35,36], mitomycin C and cisplatin [37][38][39], and cisplatin plus FU [40]. Radiation therapy combined with cisplatin therapy [41][42][43] has been associated with high levels of partial and complete tumor response in patients with locally advanced head and neck cancer.…”