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Chemoradiation for Locally Advanced Squamous Cell Carcinoma of the Head and Neck for Organ Preservation and Palliation
Michael E. Poole, PA-C, MPH;
Scott L. Sailer, MD;
Julian G. Rosenman, MD;
Joel E. Tepper, MD;
Mark C. Weissler, MD;
William W. Shockley, MD;
Wendell G. Yarbrough, MD;
Harold C. Pillsbury III, MD;
Michael J. Schell, PhD;
Stephen A. Bernard, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1446-1450.
Objectives To measure the efficacy and toxic effects of our chemoradiotherapy regimen
by means of response and survival in patients with advanced squamous cell
carcinoma of the head and neck (HNSCC) for organ preservation in resectable
disease or palliation in unresectable disease.
Design All patients underwent evaluation by the multidisciplinary head and
neck cancer team, with pathological diagnosis and staging. All patients underwent
assessment for response to therapy using results of physical examination and
radiologic imaging. Patients were followed up at 3-month intervals for a planned
period of 5 years.
Setting Academic center.
Patients Thirty-eight previously untreated patients with newly diagnosed HNSCC
were treated from June 1, 1996, through December 31, 1998, of whom 20 had
resectable and 18 had unresectable tumors.
Intervention Patients received intravenous cisplatin, 100 mg/m2 for 1
hour on days 1 and 29; a 24-hour continuous infusion of fluorouracil, 1000
mg/m2 on days 1 through 4 and 29 through 32; and radiation therapy,
150 rad twice daily for 12 days. The patients were given a 7- to 10-day break,
and radiation therapy was restarted on day 29 for 12 additional days (total
dose, 7200 rad).
Main Outcome Measures Complete, partial, and total response rates; disease-free survival;
overall survival; and toxic effects.
Results Toxic effects of treatment were moderately severe, including grades
III to IV mucositis (89%), neutropenia (71%), and renal toxic effects (8%).
In the 18 patients in the unresectable group, complete response in the 17
primary tumors and 15 cervical nodal metastases was achieved in 12 (71%) and
9 (60%), respectively; in the 20 patients undergoing organ preservation, complete
response rates were 100% in the 23 primary tumors and 15 cervical nodal metastases.
Complete response for all 38 patients was achieved in 31 (82%). In the unresectable
group, the Kaplan-Meier relapse-free survival estimate is 56%, with follow-up
from 29 to 45 months. In the organ preservation group, 75% of patients are
alive without disease, and 8 have been followed up for 36 to 48 months. Of
the 5 patients who have died, only 2 died of disease, with recurrences at
13.0 and 16.5 months.
Conclusions Chemoradiotherapy consisting of cisplatin, fluorouracil, and twice-daily
external beam radiation is highly effective in achieving durable complete
responses in patients with resectable HNSCC undergoing organ preservation
and patients with unresectable HNSCC undergoing palliation. Toxic effects
of this regimen were moderate to severe.
From the Division of Hematology/Oncology, Department of Medicine (Mr
Poole and Dr Bernard), and the Departments of Radiation Oncology (Drs Sailer,
Rosenman, and Tepper) and Otolaryngology–Head and Neck Surgery (Drs
Weissler, Shockley, Yarbrough, and Pillsbury), University of North Carolina
School of Medicine, and the University of North Carolina Lineberger Comprehensive
Cancer Center (Dr Schell), Chapel Hill.
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