Cisplatin-based chemotherapy: the only alternative in chemoradiation of head and neck cancer? Experience of the Institute of Oncology, Ljubljana, Slovenia

Abstract

Summary Background Concomitant chemoradiation is a widely used therapeutic concept in intensified locoregional treatment of high risk head and neck cancer patients. In this context, cisplatin monotherapy or in combination with other chemotherapeutics is recognized as the most effective drug to be added to radiotherapy. Aim The aim of this review is to present the rationale for combining radiotherapy with cisplatin in the treatment of head and neck cancer and to summarize the experience of the Institute of Oncology Ljubljana, Slovenia, gained through two prospective randomized trials on chemoradiation with mitomycin C and bleomycin in operable as well as inoperable head and neck cancer patients. Furthermore, recent developments in technology and biological drug modeling are discussed, which are considered to have a potential to add significantly to the locoregional effectiveness of radiotherapy. Materials/Methods References were retrieved using the online data base of the National Library of Medicine (PubMed: http://www.ncbi.nlm.nih.gov/PubMed ). Terms used included: head and neck carcinoma, squamous cell carcinoma, concomitant chemoradiotherapy, cisplatin, mitomycin C, bleomycin. The results of studies using cisplatin-based chemoradiation regimens in the treatment of patients with inoperable tumors and on postoperative stetting were compared with the results of the studies, conducted at the Institute of Oncology and ENT Department at the Clinical Center Ljubljana, Slovenia. Results When comparing mitomycin C-bleomycin chemotherapy with other comparable series on exclusively inoperable oropharyngeal cancer, but with cisplatin (or carboplatin) and 5-fluorouracil chemotherapy, and to standard dose cisplatin regimen used in postoperative setting, the effectiveness of our unconventional drug combination appeared to be at least equivalent to the well established platinum-based chemotherapy standard. Conclusions At the moment, concomitant chemoradiation with cisplatin-based chemotherapy is the most widely used way for potentiation of locoregional effect of radiotherapy in high risk head and neck cancer patients. Our clinical experiences with mitomycin C and bleomycin chemoradiation showed that there was still a window of opportunity to achieve equivalent clinical results with other drug combinations.