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Preoperative Chemotherapy-Sensitized Radiation Therapy for Cervical Metastases in Head and Neck Cancer
Matthew M. Puc, MD;
Francis A. Chrzanowski, Jr, MD;
Hoang S. Tran, MD;
Li Liu, MD;
Arvin S. Glicksman, MD;
Christine Landman, MD;
Gus J. Slotman, MD
Arch Otolaryngol Head Neck Surg. 2000;126:337-342.
Objective To determine the efficacy of concurrent preoperative cisplatin chemotherapy and radiotherapy (CT/RT) for patients with advanced head and neck cancer and cervical metastatic disease.
Design Retrospective analysis.
Setting University hospitals.
Patients Eighty-eight patients with operable stage III and IV squamous cell carcinoma of the head and neck and palpable cervical lymphogenous metastases received preoperative concurrent CT/RT followed by planned neck dissection.
Interventions All patients undergoing CT/RT received concomitant continuous infusions of cisplatin (20 mg/m2) on days 1 to 4 and 22 to 25 of CT/RT. Thirty-nine patients underwent single-fraction (1.8-Gy) radiotherapy to 45.0 Gy, and 49 patients received 10 single-fraction (1.8-Gy) treatments, which were hyperfractionated (1.2-Gy twice a day) to 46.8 Gy.
Main Outcome Measures The 71 patients for whom complete post-CT/RT data were available were evaluated for clinical response in addition to survival. Histologic complete response (HCR) was confirmed from planned neck dissection specimens (n=48) after clinical complete response (CCR) from initial CT/RT. Kaplan-Meier statistical analysis for disease-specific survival and overall survival was performed on all 88 patients who received CT/RT.
Results A CCR and an HCR were noted in 78% (18/23) and 59% (10/17) of patients with N1 lesions, respectively, and in 60% (29/48) and 45% (14/31) of patients with N2-3 lesions, respectively. The percentage of patients with CCR who also had HCR was 67% (10/15) for patients with N1 lesions and 54% (14/26) for patients with N2-3 lesions. With a median follow-up of 18.5 months, the Kaplan-Meier disease-specific survival rate at 54 months (n=88) was 70% (21/30) for patients with N1 lesions, 60% (24/40) for patients with N2 lesions, and 39% (7/18) for patients with N3 lesions. The overall survival and disease-specific survival rates at 5 years for all nodal groups combined were 36% (32/88) and 59% (52/88), respectively.
Conclusions A CCR to CT/RT was achieved in nearly two thirds of patients with head and neck cervical lymphogenous metastases, independent of nodal tumor load. Most patients (59% [24/41]) with CCR were pathologically tumor free before neck dissection.
From the Department of Surgery, Cooper Hospital–University Medical Center, University of Medicine & Dentistry of New Jersey–Robert Wood Johnson Medical School, Camden (Drs Puc, Chrzanowski, Tran, and Slotman); and the Departments of Radiation Oncology, Roger Williams Medical Center–Brown University, Providence, RI (Drs Liu and Glicksman), and Kantoysspital Hospital, Basel, Switzerland (Dr Landman).
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