Concurrent Cisplatin - Radiation Therapy in Locally Advanced Head & Neck Cancers: Preliminary Report

Kim, In Ah

Abstract

PURPOSE: This study tried to evaluate the effectiveness of combined treatment using radiation therapy and concurrent cisplatin as a radiosensitizer in the management of locally advanced head and neck cancer.
MATERIALS AND METHODS
From January 1995 to August 1998, 29 evaluable patients with locally advanced head & neck cancers (AJCC stage II-IV) were received curative radiation therapy (total 70-75.6 Gy/35 -42 fractions , 1.8-2 Gy/fraction) and concurrent cisplatin chemotherapy (100 mg/m2, D1, D22, D43). The neck dissections were performed for residual lymphadenopathy. Follow- up ranged from 5 to 55 months (median 24 months).
RESULTS
Twenty- one (72.4%) patients achieved clinical complete responses. The partial response and minimal response rates were 17.2% and 10.4%, respectively. Locoregional failure rate was 27.6%, and included 6 patients with local failures , 4 patients with regional failures, and 2 patients with combined local and regional failures. Four of 29 patients (13.8%) developed distant metastasis. The disease free survival rate at 3 years was 60%. Nasopharyngeal primary tumors or complete responders showed significantly higher disease free survival rate. The grade 3 mucositis and nausea/vomiting was noted in 34.5%, respectively. Major prolongation of radiation therapy duration was inevitable in three patients. Twenty- one patients (72.4%) completed 3 courses of cisplatin and 5 patients received 2 courses of cisplatin. Three patients received only one course of cisplatin due to nephrotoxicity and neurotoxicity, and then changed to 5- FU regimen.
CONCLUSIONS
Concurrent cisplatin- radiation therapy in locally advanced head and neck cancer showed high response rate, reasonable locoregional control, and survival rate. As expected, acute toxicities were increased, but compliance to treatment was acceptable. Assess ment of the effect of the combination in this setting requires further accrual and follow- up.