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Aggressive Concurrent Chemoradiotherapy for Squamous Cell Head and Neck Cancer
An 8-Year Single-Institution Experience
Pierre Lavertu, MD;
David J. Adelstein, MD;
Jerrold P. Saxton, MD;
Michelle Secic, MS;
Isaac Eliachar, MD;
Marshall Strome, MD;
Marjorie A. Larto, RN;
Benjamin G. Wood, MD
Arch Otolaryngol Head Neck Surg. 1999;125:142-148.
Background Since 1989, 105 patients with squamous head and neck cancer have been treated with combined chemoradiotherapy.
Objective To examine the effectiveness of using combined chemoradiotherapy on patients with squamous head and neck cancer.
Design Eight-year (1989-1997) single-institution evaluation of 105 patients.
Methods Treatment consisted of fluorouracil, 1000 mg/m2 per day, and cisplatin, 20 mg/m2 per day, both given as continuous infusions during 4 days beginning on day 1 and 22 of a concurrent radiotherapy course. Radiation was given in single daily fractions of 1.8 to 2 Gy, to a total dose of 66 to 72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Planned neck dissection was recommended for all patients with N2+ neck disease, irrespective of clinical response.
Results The 105-patient cohort consisted of 79 men and 26 women. The primary site was identified in the oral cavity in 6, oropharynx in 46, larynx in 30, and hypopharynx in 20 patients. Two patients had multiple primaries and 1 patient had an unknown primary. There were 4 patients with stage II, 24 with stage III, and 77 with stage IV disease. Grade 3 and 4 chemoradiotherapy toxic effects included mucositis in 88% of patients, cutaneous reaction in 50%, neutropenia in 49%, thrombocytopenia in 12%, and nausea in 5%. There were no deaths secondary to treatment. The mean weight loss was 12% of initial body weight. To date, primary site persistence or recurrence has occurred in only 14 patients (13%). With a mean follow-up of 39 months, 66 patients (63%) are alive and free of disease. The Kaplan-Meier 4-year projected overall survival is 60% with a disease-specific survival of 74%, a distant metastasis-free survival of 84%, and an overall survival with primary site preserved of 54%.
Conclusions This chemoradiotherapy regimen, although toxic, is tolerable with appropriate supportive intervention. Locoregional and distant control are likely. Primary site conservation is possible in most patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancer.
From the Department of Otolaryngology and Head and Neck Surgery, University Hospitals of Cleveland, Case Western Reserve University (Dr Lavertu); and Departments of Hematology and Medical Oncology (Dr Adelstein and Ms Larto), Radiation Oncology (Dr Saxton), Biostatistics and Epidemiology (Ms Secic), and Otolaryngology and Communicative Disorders (Drs Eliachar, Strome, and Wood), Cleveland Clinic Foundation, Cleveland, Ohio.
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