Adjuvant Therapy for Patients with Oral Cavity Cancer

  • C. Wesley Hodge
  • Deepak Khuntia
  • Rafael Manon
  • Paul M. Harari
Chapter

Abstract

Locoregionally advanced oral cavity cancer is commonly treated using a combined modality approach in an effort to maximize tumor control. Radiotherapy, either alone or in combination with chemotherapy, is generally administered following surgery. Radiation doses on the order of 60 Gy are typically recommended post-operatively, although higher doses may be advisable in cases of extracapsular nodal extension or gross residual disease. Advances in radiation delivery techniques including intensity modulated radiation therapy (IMRT) have the potential to reduce normal tissue toxicities without compromising the likelihood of tumor control. The role of concomitant chemotherapy in the adjuvant setting has evolved considerably in the last 10 years, and its use has recently been validated for selected high-risk patients on the basis of two large multi-institutional randomized trials. Newer approaches include the evaluation of targeted agents, with the goal of preserving a beneficial effect with radiation while further diminishing treatment related side effects.

Keywords

Toxicity Europe Fractionation Immobilization Cesium 

References

  1. Adelstein DJ, Li Y, Adams GL et al (2003) An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21(1):92–98CrossRefPubMedGoogle Scholar
  2. Al-Sarraf M, Pajak TF, Byhardt RW et al (1997) Postoperative radiotherapy with concurrent cisplatin appears to improve locoregional control of advanced, resectable head and neck cancers: RTOG 88-24. Int J Radiat Oncol Biol Phys 37(4):777–782PubMedGoogle Scholar
  3. Ang KK, Trotti A, Brown BW et al (2001) Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 51(3):571–578PubMedGoogle Scholar
  4. Awwad HK, Khafagy Y, Barsoum M et al (1992) Accelerated versus conventional fractionation in the postoperative irradiation of locally advanced head and neck cancer: Influence of tumour proliferation. Radiother Oncol 25(4):261–266CrossRefPubMedGoogle Scholar
  5. Bernier J, Domenge C, Ozsahin M et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMedGoogle Scholar
  6. Bernier J, Cooper JS, Pajak TF et al (2005) Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27(10):843–850CrossRefPubMedGoogle Scholar
  7. Bonner JA, Harari PM, Giralt J et al (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354(6):567–78CrossRefPubMedGoogle Scholar
  8. Brizel DM, Albers ME, Fisher SR et al (1998) Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 338(25):1798–1804CrossRefPubMedGoogle Scholar
  9. Browman GP, Hodson DI, Mackenzie RJ et al (2001) Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis. Head Neck 23(7):579–589CrossRefPubMedGoogle Scholar
  10. Byers RM, Newman R, Russell N et al (1981) Results of treatment for squamous carcinoma of the lower gum. Cancer 47(9):2236–2238CrossRefPubMedGoogle Scholar
  11. Calais G, Alfonsi M, Bardet E et al (1999) Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 91(24):2081–2086CrossRefPubMedGoogle Scholar
  12. Cooper JS, Pajak TF, Forastiere A et al (1998) Precisely defining high-risk operable head and neck tumors based on RTOG #85-03 and #88-24: Targets for postoperative radiochemotherapy? Head Neck 20(7):588–594CrossRefPubMedGoogle Scholar
  13. Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944CrossRefPubMedGoogle Scholar
  14. Cooper JS, Pajak TF, Forastiere AA et al (2006) Long-term survival results of a phase III Intergroup trial (RTOG 95–01) of surgery followed by radiotherapy vs. radiochemotherapy for resectable high risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 66(3):S14Google Scholar
  15. Daly ME, Lieskovsky Y, Pawlicki T et al (2006) Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma. Head NeckGoogle Scholar
  16. Day TA, Davis BK, Gillespie MB et al (2003) Oral cancer treatment. Curr Treat Options Oncol 4:27–41CrossRefPubMedGoogle Scholar
  17. Denis F, Garaud P, Bardet E et al (2004) Final results of the 94–01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22(1):69–76CrossRefPubMedGoogle Scholar
  18. Eisbruch A, Ship JA, Dawson LA et al (2003) Salivary gland sparing and improved target irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg 27(7):832–837CrossRefPubMedGoogle Scholar
  19. El-Sayed S, Nelson N (1996) Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials. J Clin Oncol 14(3):838–847PubMedGoogle Scholar
  20. Fiorino C, Dell’Oca I, Pierelli A et al (2006) Significant improvement in normal tissue sparing and target coverage for head and neck cancer by means of helical tomotherapy. Radiother Oncol 78(3):276–282CrossRefPubMedGoogle Scholar
  21. Fu KK, Ray JW, Chan EK et al (1976) External and interstitial radiation therapy of carcinoma of the oral tongue. A review of 32 years’ experience. AJR Am J Roentgenol 126(1):107–115PubMedGoogle Scholar
  22. Fu KK, Pajak TF, Trotti A et al (2000) A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 48(1):7–16CrossRefPubMedGoogle Scholar
  23. Harari PM, Mehta MP, Ritter MA et al (2003) Clinical promise tempered by reality in the delivery of combined chemoradiation for common solid tumors. Semin Radiat Oncol 13(1):3–12CrossRefPubMedGoogle Scholar
  24. Harari PM, Jaradat HA, Connor NP et al (2004) Refining target coverage and normal tissue avoidance with helical tomotherapy vs linac-based IMRT for oropharyngeal cancer. Int J Radiat Oncol Biol Phys 60(1):S160CrossRefGoogle Scholar
  25. Harari PM, Harris J, Kies MS et al (2007) Phase II randomized trial of surgery followed by chemoradiation plus cetuximab for high-risk squamous cell carcinoma of the head and neck (RTOG 0234). Int J Radiat Oncol Biol Phys 69(3):S13Google Scholar
  26. Hicks WL Jr, Loree TR, Garcia RI et al (1997) Squamous cell carcinoma of the floor of mouth: A 20-year review. Head Neck 19(5):400–405CrossRefPubMedGoogle Scholar
  27. Hintz B, Charyulu K, Chandler JR et al (1979) Randomized study of local control and survival following radical surgery or radiation therapy in oral and laryngeal carcinomas. J Surg Oncol 12:61–74CrossRefPubMedGoogle Scholar
  28. Huang SM, Bock JM, Harari PM (1999) Epidermal growth factor receptor blockade with C225 modulates proliferation, apoptosis, and radiosensitivity in squamous cell carcinomas of the head and neck. Cancer Res 59(8):1935–1940PubMedGoogle Scholar
  29. Langendijk JA, de Jong MA, Leemans CR et al (2003) Postoperative radiotherapy in squamous cell carcinoma of the oral cavity: The importance of the overall treatment time. Int J Radiat Oncol Biol Phys 57(3):693–700PubMedGoogle Scholar
  30. Lapeyre M, Bollet MA, Racadot S et al (2004) Postoperative brachytherapy alone and combined postoperative radiotherapy and brachytherapy boost for squamous cell carcinoma of the oral cavity, with positive or close margins. Head Neck 26(3):216–223CrossRefPubMedGoogle Scholar
  31. Marcial VA, Pajak TF, Mohiuddin M et al (1990) Concomitant cisplatin chemotherapy and radiotherapy in advanced mucosal squamous cell carcinoma of the head and neck Long-term results of the Radiation Therapy Oncology Group study 81–17. Cancer 66(9):1861–1868CrossRefPubMedGoogle Scholar
  32. Merlano M, Benasso M, Corvo R et al (1996) Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88(9):583–589CrossRefPubMedGoogle Scholar
  33. Milas L, Mason K, Hunter N et al (2000) In vivo enhancement of tumor radioresponse by C225 antiepidermal growth factor receptor antibody. Clin Cancer Res 6(2):701–708PubMedGoogle Scholar
  34. Miller KL, Shafman TD, Anscher MS et al (2005) Bronchial stenosis: An underreported complication of high-dose external beam radiotherapy for lung cancer? Int J Radiat Oncol Biol Phys 61(1):64–69PubMedGoogle Scholar
  35. Mishra RC, Singh DN, Mishra TK (1996) Post-operative radiotherapy in carcinoma of buccal mucosa, a prospective randomized trial. Eur J Surg Oncol 22(5):502–504CrossRefPubMedGoogle Scholar
  36. Mohanti BK, Bansal M, Bahadur S et al (2001) Interstitial brachytherapy with or without external beam irradiation in head and neck cancer: Institute Rotary Cancer Hospital experience. Clin Oncol (R Coll Radiol) 13(5):345–352Google Scholar
  37. Munro AJ (1995) An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer. Br J Cancer 71(1):83–91PubMedGoogle Scholar
  38. Niewald M, Barbie O, Schnabel K et al (1996) Risk factors and dose-effect relationship for osteoradionecrosis after hyperfractionated and conventionally fractionated radiotherapy for oral cancer. Br J Radiol 69(825):847–851CrossRefPubMedGoogle Scholar
  39. Peters LJ, Ang KK, Thames HD Jr (1988) Accelerated fractionation in the radiation treatment of head and neck cancer. A critical comparison of different strategies. Acta Oncol 27(2):185–194CrossRefPubMedGoogle Scholar
  40. Peters LJ, Goepfert H, Ang KK et al (1993) Evaluation of the dose for postoperative radiation therapy of head and neck cancer: First report of a prospective randomized trial. Int J Radiat Oncol Biol Phys 26(1):3–11PubMedGoogle Scholar
  41. Pignon JP, Bourhis J, Domenge C et al (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: Three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 355(9208):949–955PubMedGoogle Scholar
  42. Pignon JP, le Maitre A, Bourhis J (2007) Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): An update. Int J Radiat Oncol Biol Phys 69(Suppl 2):S112–S114PubMedGoogle Scholar
  43. Robertson AG, Soutar DS, Paul J et al (1998) Early closure of a randomized trial: Surgery and postoperative radiotherapy versus radiotherapy in the management of intra-oral tumours. Clin Oncol (R Coll Radiol) 10(3):155–160Google Scholar
  44. Rodgers LW Jr, Stringer SP, Mendenhall WM et al (1993) Management of squamous cell carcinoma of the floor of mouth. Head Neck 15(1):16–19CrossRefPubMedGoogle Scholar
  45. Rosenthal DI, Liu L, Lee JH et al (2002) Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck. Head Neck 24(2):115–126CrossRefPubMedGoogle Scholar
  46. Sanguineti G, Richetti A, Bignardi M et al (2005) Accelerated versus conventional fractionated postoperative radiotherapy for advanced head and neck cancer: results of a multicenter Phase III study. Int J Radiat Oncol Biol Phys 61(3):762–771PubMedGoogle Scholar
  47. Shah JP, Lydiatt W (1995) Treatment of cancer of the head and neck. CA Cancer J Clin 45(6):352–368CrossRefPubMedGoogle Scholar
  48. Sheng K, Molloy JA, Read PW (2006) Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: A comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy. Int J Radiat Oncol Biol Phys 65(3):917–923PubMedGoogle Scholar
  49. Shibuya H, Horiuchi J, Suzuki S et al (1984) Oral carcinoma of the upper jaw. Results of radiation treatment. Acta Radiol Oncol 23(5):331–335CrossRefPubMedGoogle Scholar
  50. Snow JB, Gelber RD, Kramer S et al (1981) Comparison of preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck. Interim report. Acta Otolaryngol 91:611–626CrossRefPubMedGoogle Scholar
  51. Staar S, Rudat V, Stuetzer H et al (2001) Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy-results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 50(5):1161–1171PubMedGoogle Scholar
  52. Strnad V (2004) Treatment of oral cavity and oropharyngeal cancer. Indications, technical aspects, and results of interstitial brachytherapy. Strahlenther Onkol 180(11):710–717CrossRefPubMedGoogle Scholar
  53. Studer G, Studer SP, Zwahlen RA et al (2006) Osteoradionecrosis of the mandible: Minimized risk profile following intensity-modulated radiation therapy (IMRT). Strahlenther Onkol 182(5):283–288CrossRefPubMedGoogle Scholar
  54. Vikram B, Strong EW, Shah J et al (1980) Elective postoperative radiation therapy in stages III and IV epidermoid carcinoma of the head and neck. Am J Surg 140(4):580–584CrossRefPubMedGoogle Scholar
  55. Wang CC, Boyer A, Mendiondo O (1976) Afterloading interstitial radiation therapy. Int J Radiat Oncol Biol Phys 1(3–4):365–368PubMedGoogle Scholar
  56. Wendt TG, Grabenbauer GG, Rodel CM et al (1998) Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: A randomized multicenter study. J Clin Oncol 16(4):1318–1324PubMedGoogle Scholar
  57. Yao M, Dornfeld KJ, Buatti JM et al (2005) Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma – the University of Iowa experience. Int J Radiat Oncol Biol Phys 63(2):410–421PubMedGoogle Scholar
  58. Zelefsky MJ, Harrison LB, Fass DE et al (1990) Postoperative radiotherapy for oral cavity cancers: Impact of anatomic subsite on treatment outcome. Head Neck 12(6):470–475CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • C. Wesley Hodge
  • Deepak Khuntia
  • Rafael Manon
  • Paul M. Harari
    • 1
  1. 1.Department of Human OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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