Abstract
BackgroundConcurrent chemoradiation is the standard treatment for patients with advanced head and neck squamous cell carcinoma (HNSCC).The present study was carried out to assess the feasibility and efficacy of low-dose gemcitabine as a radiosensitizer when used during radical therapeutic management of patients with locally advanced HNSCC.Patients and methodsFifty-two patients with locally advanced HNSCC (stage III, 50%; stage IVa, 50%) were enrolled during the period from July 2008 to December 2010. All received a course of radiotherapy (70 Gy over 7 weeks) concurrent with weekly infusions of gemcitabine at 50 mg/m2.ResultsAll patients were available for toxicity and response. Severe mucositis (grade 3-4) was observed in 76% of patients. Severe hematological toxicity was uncommon. Xerostomia was the most common late toxicity in 34 patients (65.4%). The rate of complete and partial response rate was 67.3% and 21.1%, respectively, with an overall response rate of 88.45%. Two years progression-free survival and disease-free survival were 46% and 38.46%, respectively.ConclusionUsing low-dose gemcitabine concurrent with radiotherapy maintains high response rate with low systemic toxicity, in spite of severe mucositis in a high percentage of patients.
Highlights
Head and neck malignancies constitute 5% of all cancers worldwide [1]
Advanced head and neck carcinoma is generally treated by a combination of chemoradiotherapy, with or without surgery [3]
Chemotherapy has been combined with radiation in an attempt to improve the outcome, the most promising approach being the administration of chemotherapy concurrent with radiation [4,5]
Summary
Head and neck malignancies constitute 5% of all cancers worldwide [1]. The majority of these patients diagnosed with locally advanced disease and with lymph node involvement in up to 30-50% [2].Locoregionally advanced head and neck carcinoma is generally treated by a combination of chemoradiotherapy, with or without surgery [3].Because of the high incidence of advanced disease at presentation and local failure rates (50-60%), the management of head and neck carcinoma is a challenging proposition [4].Radiation has been the standard treatment for locally advanced cancer of the head and neck. Head and neck malignancies constitute 5% of all cancers worldwide [1] The majority of these patients diagnosed with locally advanced disease and with lymph node involvement in up to 30-50% [2]. Because of the high incidence of advanced disease at presentation and local failure rates (50-60%), the management of head and neck carcinoma is a challenging proposition [4]. Radiation has been the standard treatment for locally advanced cancer of the head and neck These patients, when treated with exclusive radiation, have a 5-year survival rate of less than 25%, and most treatment failures occur locally or regionally within the irradiated fields. Concurrent chemoradiation is the standard treatment for patients with advanced head and neck squamous cell carcinoma (HNSCC).
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