Skip to main content
SpringerLink
Log in

Curative treatment of head and neck squamous cell carcinoma

Organ preservation strategies in clinical routine in German-speaking countries

Kurative Therapie von Plattenepithelkarzinomen im Kopf-Hals-Bereich

Organerhaltende Strategien in der klinischen Routine in deutschsprachigen Ländern

  • Leitthema
  • Published:
HNO Aims and scope Submit manuscript

Abstract

Introduction

For the treatment of head and neck squamous cell carcinoma (HNSCC), there are currently no official standard of care guidelines in German-speaking countries, with the exception of oral cavity cancer. In order to learn about the applied treatment modalities in the clinical routine, we conducted a web-based survey to evaluate the local standards of palliative and curative treatment of HNSCC. This article focuses on the curative treatment options and organ preservation strategies.

Materials and methods

The survey consisted of a web-based questionnaire that was performed between November 2013 and July 2014. The questionnaire included ten multiple-choice questions and four open questions in the section about curative treatment.

Results

Altogether, 62 of the 204 addressed centers participated in the survey. For primary chemoradiation (CRT), most centers used a platinum-based chemotherapy (52/54, 96.3 %). Induction chemotherapy (ICT) was offered in 37 of the 62 centers (60 %). In oral cavity cancer, CRT and ICT were used in 37.5 and 4.3 % of the cases, respectively. In oropharyngeal cancer, CRT and ICT were applied in 44.5 and 10.3 % of cases, respectively. For hypopharyngeal cancer, 44.8 % of the patients received CRT and 11.8 % received ICT, while for laryngeal cancer 35.9 % received CRT and 9.4 % underwent ICT.

Conclusion

Our data showed that a variety of treatments are used for HNSCC within German-speaking countries. Many centers offer ICT. The majority of the hospitals uses platinum-based therapy as a conservative first-line option in their organ preservation protocols.

Zusammenfassung

Einleitung

Für die Behandlung von Plattenepithelkarzinomen im Kopf-Hals-Bereich (HNSCC) gibt es im deutschsprachigen Raum bisher keine Therapieleitlinien. Um einen Eindruck von der Lebenswirklichkeit der Behandlung derartiger Erkrankungen zu erlangen, haben wir einen online-basierten Fragebogen entwickelt, der die Klinikstandards für kurative und palliative Therapie der HNSCC abfragt. Dieser Artikel konzentriert sich auf den kurativen Fragebogenteil und den Organerhalt.

Methoden

Die Umfrage wurde mittels eines web-basierten Fragebogens im Zeitraum zwischen November 2013 und Juli 2014 durchgeführt. Der Fragebogen beinhaltete 10 Multiple-Choice Fragen und vier offene Fragen zur kurativen Therapie der HNSCC.

Ergebnisse

Insgesamt 62/204 befragten Zentren nahmen an der Umfrage teil. Für die primäre Radiochemotherapie (RCT) wurde in der Regel eine platinbasierte Chemotherapie verwendet (52/54; 96,3 %). 37/62 (60 %) der Zentren boten ihren Patienten eine Induktionschemotherapie (ICT) an. Für Plattenepithelkarzinome in der Mundhöhle wurde die RCT in 37,5 % der Fälle eingesetzt, die ICT in 4,3 % der Fälle. Oropharynxkarzinome wurden in 44,5 % der Fälle mit RCT behandelt und in 10,3 % der Fälle einer ICT zugeführt. 44,8 % der Hypopharynxkarzinome erhielten eine RCT, während 11,8 % eine ICT erhielten. Für das Larynxkarzinom lagen die Angaben für RCT bei 35,9 % und für ICT bei 9,4 %.

Diskussion und Schlussfolgerung

Unsere Daten zeigen eine große Variabilität bei der Therapie durch die jeweiligen Zentren im deutschsprachigen Raum. Die ICT wird häufig eingesetzt. Die Mehrheit der Zentren bevorzugt eine platinbasierte Erstlinientherapie in organerhaltenden Behandlungsprotokollen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abgral R, Le Roux PY, Keromnes N et al (2012) Early prediction of survival following induction chemotherapy with DCF (docetaxel, cisplatin, 5‑fluorouracil) using FDG PET/CT imaging in patients with locally advanced head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging 39:1839–1847

    Article  CAS  PubMed  Google Scholar 

  2. Ang K, Zhang Q, Wheeler RH et al (2010) A phase III trial (RTOG 0129) of two radiation-cisplatin regimens for head and neck carcinomas (HNC): Impact of radiation and cisplatin intensity on outcome. ASCO Meeting Abstracts 28:5507

    Google Scholar 

  3. Basheeth N, O’leary G, Sheahan P (2014) Pharyngocutaneous fistula after salvage laryngectomy: impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection. Head Neck 36:580–584

    Article  PubMed  Google Scholar 

  4. Beckmann GK, Hoppe F, Pfreundner L et al (2005) Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer. Head Neck 27:36–43

    Article  PubMed  Google Scholar 

  5. 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 354:567–578

    Article  CAS  PubMed  Google Scholar 

  6. Bonner JA, Harari PM, Giralt J et al (2010) Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5‑year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol 11:21–28

    Article  CAS  PubMed  Google Scholar 

  7. Bourhis J, Sire C, Graff P et al (2012) Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncol 13:145–153

    Article  PubMed  Google Scholar 

  8. Budach V, Cho C‑H, Sedlmaier B et al (2012) Five years’ results of the German ARO 04-01 trial of concurrent 72 Gy hyperfractionated accelerated radiation therapy (HART) plus once weekly cisplatinum/5-FU versus mitomycin C/5-FU in stage IV head and neck cancer. ASCO Meeting Abstracts 30:5512

    Google Scholar 

  9. Budach V, Stromberger C, Poettgen C et al (2015) Hyperfractionated accelerated radiation therapy (HART) of 70.6 Gy with concurrent 5‑FU/Mitomycin C is superior to HART of 77.6 Gy alone in locally advanced head and neck cancer: long-term results of the ARO 95-06 randomized phase III trial. Int J Radiat Oncol Biol Phys 91(5):916–924

    Article  CAS  PubMed  Google Scholar 

  10. Cohen EE, Karrison TG, Kocherginsky M et al (2014) Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 32:2735–2743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. 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 22:69–76

    Article  PubMed  Google Scholar 

  12. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403

    Article  CAS  PubMed  Google Scholar 

  13. Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098

    Article  CAS  PubMed  Google Scholar 

  14. Forastiere AA, Maor M, Weber RS et al (2006) Long-term results of Intergroup RTOG 91-11: A phase III trial to preserve the larynx – Induction cisplatin/5-FU and radiation therapy versus concurrent cisplatin and radiation therapy versus radiation therapy. ASCO Meeting Abstracts 24:5517

    Google Scholar 

  15. Forastiere AA, Zhang Q, Weber RS et al (2012) Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 26:26

    Google Scholar 

  16. Garden AS, Harris J, Vokes EE et al (2004) Preliminary results of radiation therapy oncology group 97-03: a randomized phase ii trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol 22:2856–2864

    Article  CAS  PubMed  Google Scholar 

  17. Haddad R, O’neill A, Rabinowits G et al (2013) Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 14:257–264

    Article  CAS  PubMed  Google Scholar 

  18. Hutcheson KA, Jantharapattana K, Barringer DA et al (2012) Functional and oncological outcomes of primary versus salvage transoral laser microsurgery for supraglottic carcinoma. Ann Otol Rhinol Laryngol 121:664–670

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kimmeyer J, Kurzweg T, Hoffmann TK, et al (2016) Oncologic treatment landscape for head and neck squamous cell carcinoma. Treatment infrastructure in German-speaking countries. HNO. doi:10.1007/s00106-016-0188-9

  20. Medina JA, Rueda A, De Pasos AS et al (2006) A phase II study of concomitant boost radiation plus concurrent weekly cisplatin for locally advanced unresectable head and neck carcinomas. Radiother Oncol 79:34–38

    Article  CAS  PubMed  Google Scholar 

  21. Paleri V, Drinnan M, Van Den Brekel MW et al (2014) Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 124:1848–1853

    Article  PubMed  Google Scholar 

  22. Petrelli F, Coinu A, Riboldi V et al (2014) Concomitant platinum-based chemotherapy or cetuximab with radiotherapy for locally advanced head and neck cancer: a systematic review and meta-analysis of published studies. Oral Oncol 50:1041–1048

    Article  CAS  PubMed  Google Scholar 

  23. Pignon JP, Le Maitre A, Maillard E et al (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14

    Article  PubMed  Google Scholar 

  24. Posner MR, Hershock DM, Blajman CR et al (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357:1705–1715

    Article  CAS  PubMed  Google Scholar 

  25. Semrau S, Haderlein M, Schmidt D et al (2014) Single-cycle induction chemotherapy followed by chemoradiotherapy or surgery in patients with head and neck cancer: What are the best predictors of remission and prognosis? Cancer 121(8):1214–1222

    Article  PubMed  Google Scholar 

  26. Semrau S, Schmidt D, Lell M et al (2013) Results of chemoselection with short induction chemotherapy followed by chemoradiation or surgery in the treatment of functionally inoperable carcinomas of the pharynx and larynx. Oral Oncol 49:454–460

    Article  PubMed  Google Scholar 

  27. Suntharalingam M, Haas ML, Conley BA et al (2000) The use of carboplatin and paclitaxel with daily radiotherapy in patients with locally advanced squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 47:49–56

    Article  CAS  PubMed  Google Scholar 

  28. Taylor SGT, Murthy AK, Vannetzel JM et al (1994) Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 12:385–395

    PubMed  Google Scholar 

  29. Vermorken JB, Remenar E, Van Herpen C et al (2007) Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357:1695–1704

    Article  CAS  PubMed  Google Scholar 

  30. Wolf GT, Hong WK, Gross Fisher S et al (1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med 324:1685–1690

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank all participating treatment centers for their time in completing this survey and their detailed responses.

Author information

Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology, Head & Neck Surgery and Oncology, Head & Neck Cancer Center of the University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany

    T. Kurzweg, R. Knecht, C.-J. Busch & B. B. Lörincz

  2. Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany

    J. Kimmeyer, T. K. Hoffmann, P. J. Schuler & S. Laban

Authors
  1. T. Kurzweg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Kimmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Knecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. K. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C.-J. Busch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. B. Lörincz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. J. Schuler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Laban
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Kurzweg.

Ethics declarations

Conflict of interest

R. Knecht is a member of the scientific advisory board for Merck Serono, Sanofi Aventis, Boehringer Ingelheim, and Bayer Healthcare Leverkusen. T. Kurzweg, J. Kimmeyer, T. K. Hoffmann, C.-J. Busch, B. B. Lörincz, P. J. Schuler, and S. Laban state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Additional information

This article should be considered an original contribution but has been classified as a main topic for technical reasons. Dieser Beitrag ist als eine Originalarbeit anzusehen und aus formalen Gründen im Leitthema dieser Ausgabe eingeordnet.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurzweg, T., Kimmeyer, J., Knecht, R. et al. Curative treatment of head and neck squamous cell carcinoma. HNO 64, 501–507 (2016). https://doi.org/10.1007/s00106-016-0191-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-016-0191-1

Keywords

Schlüsselwörter

Search

Navigation