Concurrent, cisplatin-based chemotherapy with accelerated radiotherapy for advanced head and neck cancer patients

Abstract

17019 Background As the altered fractionation has become a standard radiation treatment (RT) for moderately advanced head and neck cancer (H&NC) patients, we decided to make use the accelerated fractionation with systemic cisplatin-based therapy for highly advanced lesions. Methods Fifty eight patients with H&NC in clinical stage IV treated between 1999 and 2003 were prospectively evaluated. Treatment assumed the administration of 3 courses of cisplatin (100mg/m2) and vinorelbin, and continuously fractionated irradiation (7 fractions per week) to the total dose of 68Gy in 40 fractions. Results One patient death could be related to the treatment. Planned RT dose has been realized in 56 patients (96%) but in 11 patients total dose was escalated within the range 70–78Gy because of residual lesion investigated at the end of treatment. Between 15th and 48th day of combined treatment all patients developed confluent mucositis, which lasted about 60 days (median value). All required anti-inflammatory and analgesic treatment including corticosteroids and opioids respectively. Tube feeding was realized in 15% of pts. During the first year of the study all 16 consecutive patients have been developing grade 3–4 neutropenia and 31% of them grade 3–4 anaemia. This was the reason to give only 2 courses of chemotherapy for 12 of them (75%) and to modify the schedule with drug-dose reduction: by 25% the dose of cisplatin and by 33% the dose of vinorelbin. Generally all patients received at least 2 courses of chemotherapy and 44of them (76%) realized full prescribed chemotherapy regimen (in 28 pts chemotherapy was widened up to 4 courses). Median follow-up is 35 months. Three-year loco-regional control and disease free survival rates are respectively 60% and 50%. During follow-up 15 patients died - 12 of them from cancer disease, in 9 patients salvage surgery was performed: 6 lymph node resections and 3 resections of residual tumour. Organ preservation has been noted at 65% of patients. Conclusions Concomitant chemo-radiotherapy in patients with advanced, fairly unresectable head and neck tumours produces very promising early results. After chemotherapy dose reduction the treatment is feasible in clinical practice and bow us towards a multicenter phase III study. No significant financial relationships to disclose.