Abstract
PurposeTo report our experience on disease control and functional outcome using three modern combined-modality approaches for definitive radiochemotherapy of locally advanced SCCHN with modern radiotherapy techniques: radiochemotherapy (RChT), radioimmunotherapy (RIT) with cetuximab, or induction chemotherapy with docetaxel, cisplatin, and 5-FU (TPF) combined with either RChT or RIT.MethodsToxicity and outcome was retrospectively analysed in patients receiving definitive RChT, RIT, or induction chemotherapy followed by RChT or RIT between 2006 and 2009. Outcome was estimated using Kaplan-Meier analyses, toxicity was analysed according to CTCAE v 3.0.ResultsThirty-eight patients were treated with RChT, 38 patients with RIT, 16 patients received TPF followed by either RChT or RIT. Radiotherapy was mostly applied as IMRT (68%). Long-term toxicity was low, only one case of grad III dysphagia requiring oesophageal dilatation, no case of either xerostomia ≥ grade II or cervical plexopathy were observed. Median overall survival (OS) was 25.7 months (RChT) and 27.7 months (RIT), median locoregional progression-free survival (PFS) was not reached yet. Subgroup analysis showed no significant differences between TPF, RChT, and RIT despite higher age and co-morbidities in the RIT group. Results suggested improved OS, distant and overall PFS for the TPF regimen.ConclusionLate radiation effects in our cohort are rare. No significant differences in outcome between RChT and RIT were observed. Adding TPF suggests improved progression-free and overall survival, impact of TPF on locoregional PFS was marginal, therefore radiotherapeutic options for intensification of local treatment should be explored.
Highlights
The past decade has seen major changes in the clinical management of locally advanced squamous cell cancer of the head and neck (SCCHN)
All patients received irradiation to bilateral nodal levels, most patients were treated by intensity-modulated radiotherapy (IMRT) (30/38 pts in the RChT group, 22/38 pts in the RIT group), median doses to the primary and involved nodes were 68.2 Gy (RChT) and 66 Gy (RIT)
It cannot be excluded that age and performance state of the patients receiving TPF has caused parts of the improvement in progression-free and overall survival. While this may be true, our data shows that improvement of survival rates beyond the results reported in the large radiochemotherapy trials is possible in carefully selected patients and can be an option in the hands of experienced oncologists
Summary
The past decade has seen major changes in the clinical management of locally advanced squamous cell cancer of the head and neck (SCCHN). Concomitant cytostatic agents as well as major technical developments such as intensity-modulated radiotherapy (IMRT) and imageguided radiotherapy (IGRT) have changed standard practice. Concomitant platin-based radiochemotherapy has become one of the treatment standards [1,2,3]; radiochemotherapy regimen. Two recent trials evaluating taxanebased induction chemotherapy with docetaxel, cisplatin, and 5-FU (TPF) [8,9] have raised the interest in induction chemotherapy for SCCHN. Both trials resulted in an improvement of overall survival and progression-free survival. The TPF regimen is accompanied by sometimes marked toxicity and requires experienced management
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.