Preoperative chemoradiation directed by primary site rebiopsy in stage III/IV squamous head and neck cancer is associated with high rate of local regional control, but is still plagued by long-term distant failure

Abstract

5549 Background:Long term outcome was reviewed of two concurrent preoperative chemoradiation protocol studies for high staged (III/IV) head and neck (H&N) squamous cancer conducted by Brown University Oncology Group (BrUOG). Methods: Two consecutive chemo radiation protocols were done with Paclitaxel (P) (high dose 60mg/M2 in 38 H&N 53 pts or low dose P 40mg/M2 in 25 pts-H&N 67) combined with carboplatin 1 AUC and radiation with mandatory biopsy of primary site at 45Gy. If the biopsy was pathologically negative, completion chemoradiation 67–70 Gy was given to the primary site with subsequent neck dissection if indicated, otherwise surgical resection was done of the primary and neck. Results: In the total group of 67 patients from head and neck protocol H&N 53 (Stg III/ IV, 12/26) and H&N 67 ( Stg. III/IV, 9/15) complete pathologic response at the primary site was 66% and 77% respectively (75% overall). Residual disease in neck was 32%. The overall survival of 63 evaluable pts (>60 mo. follow-up) was 54%. There was no survival difference in pts requiring primary sitel resection vs. pts treated by chemoradiation alone. The long-term failure was 15% local, 5% regional and 22% at distant site. (shortest observation 6 yrs H&N 53 and 4.5 yr H&N 67). Of 22 recurrences, 14 (64%) were distant, 22% local and 15% were regional. New primarys developed in 4 pts (lung 2, esophagus 2). Results: See table. Conclusions: Preoperative chemoradiation with Stage III/IV H&N cancer directed by staged primary site biopsy is associated with high rate of tumor control of primary site by chemoradiation alone in >75% of patients and salvage surgery in the remaining pts with equivalent long term survival (>54%). Distant failure continues to be the major challenge. No significant financial relationships to disclose.