Combined modality treatment with full-dose chemotherapy and concomitant boost radiotherapy for advanced head and neck carcinoma

  • Jürg Kutter
  • Mahmut Ozsahin
  • Philippe Monnier
  • Roger Stupp
Head and Neck Oncology

Abstract

The purpose of this study was to evaluate the feasibility and efficacy of a treatment concept combining three cycles of full-dose chemotherapy (CT) with concomitant accelerated uninterrupted radiotherapy (RT). Twenty-three patients (median age: 54 years, range: 35–70) with locally advanced squamous cell carcinoma of the head and neck (SCCHN) were included. The primary tumor involved the hypopharynx (n=7), base of the tongue (n=10), nasopharynx (n=2) or upper esophagus (n=1) or its location was unknown (n=3). Treatment consisted of three cycles of chemotherapy (cisplatin 100 mg/m2 on day 1; 5-FU 1,000 mg/m2 per day for 5 days as a continuous infusion, preceded by amifostine 910 mg/m2), repeated every 3 weeks. Uninterrupted concomitant boost-accelerated RT (total dose of 70 Gy in 6 weeks) started together on day 1 of the second cycle. All but two patients received the full course of RT. Eighteen patients achieved complete remission (78%). At a median follow-up of 45 months the overall survival was 56% (95% c.i. 32–79%) and the loco-regional control 71% (95% c.i. 52–91%). Toxicity involved reversible renal insufficiency of ≥ grade II in 9 patients (39%) and neutropenic fever in 9 patients (39%). All patients suffered from moderate to severe mucositis (grade II/III), and 19 patients presented cutaneous toxicity grade III. Concomitant boost-accelerated RT combined with concurrent full-dose cisplatin/5-FU chemotherapy and amifostine is feasible with manageable, although substantial, toxicity. The overall survival of 4 years is promising. Newer regimens causing less acute mucosal and skin toxicity are needed.

Keywords

Chemoradiotherapy Head and neck cancer Organ preservation Amifostine Base of the tongue 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jürg Kutter
    • 1
  • Mahmut Ozsahin
    • 2
  • Philippe Monnier
    • 1
  • Roger Stupp
    • 3
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital (CHUV)LausanneSwitzerland
  2. 2.Department of Radiation OncologyUniversity Hospital (CHUV)LausanneSwitzerland
  3. 3.Multidisciplinary Oncology CenterUniversity Hospital (CHUV)LausanneSwitzerland

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