Korean J Otolaryngol-Head Neck Surg.  2007 Apr;50(4):327-334.

Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation in Locally Advanced Head and Neck Squamous Cell Carcinoma

• Tae K
• Keum HS
• Kang SY
• Lee HS
• Choi JH
• Kim IS
• Lee MZ
• Chun HC
• Ahn MJ

Abstract

BACKGROUND AND OBJECTIVES
Surgery with postoperative radiotherapy has been the standard treatment for locally advanced head and neck squamous cell carcinoma (HNSCC). However, the prognosis still remains dismal. To increase survival rate and organ preservation rate, alternative approach is needed. Incorporating the taxane regimen into the treatment of HNSCC, the new treatment strategy of sequential therapy has been introduced. The purpose of this study is to determine the efficacy of neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy for the HNSCC.
SUBJECTS AND METHOD
Between January 2001 and June 2005, 19 patients with HNSCC were treated with neoadjuvant chemotherapy, followed by concurrent chemoradiotherapy. The sites of primary tumors were hypopharynx in eight patients, oropharynx in six patients, and larynx in five patients. Neoadjuvant chemotherapy included 70 mg/m2 of docetaxel on day 1, 70 mg/m2 of cisplantin on day 2 and 800 mg/m2 of 5-fluorouracil on day 2-4. The cycles were repeated every three weeks. Concurrent chemoradiotherapy starts after two cycles of neoadjuvant chemotherapy. Radiation dose was 200 cGy/dayx5/week with a total of 6,000-7,000 cGy, and the concurrent chemotherapy of 20 mg/m2 of docetaxel or 20 mg/m2 of cisplantin was given weekly.
RESULTS
The median follow-up was 21 months. The overall 2-year survival rate was 70.1% and the 2-year organ preservation rate was 59.4%. The survival rate and organ preservation rate of larynx cancer patients were higher than those of hypopharynx and oropharynx cancer patients, but it was not statistically significant (p=0.09, 0.16). The patients of the lower stage showed higher survival rate and organ preservation rate, but it was not statistically significant (p=0.19, 0.48). The most common Grade 3 or 4 toxicities of neoadjuvant chemotherapy were leukopenia, anorexia, nausea and vomiting, whereas the most common Grade 3 or 4 toxicities during concurrent chemoradiotherapy were mucositis, stomatitis, and leukopenia. One patient died due to sepsis during treatment.
CONCLUSION
Neoadjuvant chemotherapy with three combined regimens followed by concurrent chemoradiotherapy might be effective treatment modality for HNSCC. Further studies with large number of patients and longer follow-up will be needed.

Keyword

Head and neck cancer; Neoadjuvant treatments; Chemoradiotherapy; Organ preservation

MeSH Terms

Anorexia
Carcinoma, Squamous Cell*
Chemoradiotherapy
Drug Therapy*
Fluorouracil
Follow-Up Studies
Head and Neck Neoplasms
Head*
Humans
Hypopharynx
Laryngeal Neoplasms
Larynx
Leukopenia
Mucositis
Nausea
Neck*
Neoadjuvant Therapy
Organ Preservation
Oropharyngeal Neoplasms
Oropharynx
Prognosis
Radiotherapy
Sepsis
Stomatitis
Survival Rate
Vomiting
Fluorouracil