Sequential induction chemotherapy followed by radical chemo-radiation in the treatment of locoregionally advanced head-and-neck cancer

Abstract

We describe a retrospective series of patients with advanced head-and-neck cancer who were treated with induction chemotherapy followed by radical chemo-radiation. Patients treated with two cycles of induction chemotherapy followed by definitive chemoradiation for squamous cell carcinoma of the head-and-neck region, from 2001 -2006 at the Royal Marsden Hospital, formed the basis of this study. Cisplatin (75 mg m À2 ) on day 1 and 5-FU (1000 mg m À2 ) day 1 -4 was the standard regimen used for induction treatment. Cisplatin (100 mg m À2 ) on day 1 and day 29 was used for concomitant treatment. The radiation was delivered using conformal technique. Tissues containing macroscopic and microscopic disease were treated to doses of 65 Gray (Gy) in 30 fractions and 50 Gy in 25 fractions, respectively. Data on patterns of relapse and acute toxicity (NCICTCv.3.0) were collected. A total of 129 patients were included, median age was 58 (range: 27 -78). The site of tumour was: oropharynx 70 (54%), larynx 30 (23%), hypopharynx 24 (19%) and other 5 (4%). The median follow-up was 19 months (range: 4 -58). Local control, disease-specific survival and overall survival at 2 years were 71%, 68% and 63%, respectively. The distant recurrence rate at 2 years was 9%. Ten patients required dose reduction during induction chemotherapy due to toxicity. The dose of 5-FU was reduced in six patients and that of cisplatin in four patients. The incidence of grade 3/4 toxicity was: neutropenia 5%, thrombocytopenia 1%, nausea and vomiting 3%. One cycle of concurrent cisplatin was omitted in 23 patients due to toxicity. Full-dose radiotherapy was administered to 98% of patients. The incidence of grade 3/4 toxicity was: skin 20%, dysphagia 65%, mucositis 60%, neutropenia 3%, anaemia 1%, nausea and vomiting 4%, nephrotoxicity 1%. Induction chemotherapy followed by radical chemo-radiation is a safe and tolerable regimen in the treatment of advanced head-and-neck cancer. Distant recurrence rates are lower with equivalent local control and survival compared to chemo-radiation alone (historical controls).

Weekly Volume and Dosimetric Changes During Chemoradiotherapy With Intensity-Modulated Radiation Therapy for Head and Neck Cancer: A Prospective Observational Study

“…Two cycles (every 21 days) of cisplatin (75 mg/m 2 ) on day 1 and 5-fluorouracil (1,000 mg/m 2 ) on days 1 to 4 was the standard regimen used for induction chemotherapy (10). Cisplatin (100 mg/m 2 ) on days 1 and 29 was used for concomitant treatment.…”

Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?

“…stroke). Patients were treated with 65 Gy in 30 fractions to planning target volume 1 (PTV 1) (primary tumour and involved nodes) and 54 Gy to the elective neck (PTV 2), as previously described [13]. Patients diagnosed with unknown primary disease received 60 Gy to the operated neck and 54 Gy to the entire mucosal tube and contralateral neck.…”

Induction Chemotherapy Followed by Concomitant Chemoradiation in Head and Neck Squamous Cell Carcinoma: A Single Institution Experience

“…Previously reported studies have shown comparable two years rates for OS (61-66%), LRC (71-76%) and DMFS (79-91%) [25][26][27]. However, these studies had larger inclusion criteria such as inclusion of nasopharynx, inclusion of T1N2 or T3N1 patients whereas our study only had one patient with stage III disease, and all others with T4 or N3 disease.…”