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Combined modality treatment with full-dose chemotherapy and concomitant boost radiotherapy for advanced head and neck carcinoma

Kutter, Jürg ; Ozsahin, Mahmut ; Monnier, Philippe ; Stupp, Roger

In: European Archives of Oto-Rhino-Laryngology and Head & Neck, 2005, vol. 262, no. 1, p. 1-7

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    Titre
    • Combined modality treatment with full-dose chemotherapy and concomitant boost radiotherapy for advanced head and neck carcinoma
    Auteur
    • Kutter, Jürg. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland
    • Ozsahin, Mahmut. Department of Radiation Oncology, University Hospital (CHUV), Lausanne, Switzerland
    • Monnier, Philippe. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland
    • Stupp, Roger. Multidisciplinary Oncology Center, University Hospital (CHUV), 46 Rue du Bugnon, 1011, Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Archives of Oto-Rhino-Laryngology and Head & Neck, 2005, vol. 262, no. 1, p. 1-7. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:318230
    Summary
    The purpose of this study was to evaluate the feasibility and efficacy of a treatment concept combining three cycles of full-dose chemotherapy (CT) with concomitant accelerated uninterrupted radiotherapy (RT). Twenty-three patients (median age: 54years, range: 35-70) with locally advanced squamous cell carcinoma of the head and neck (SCCHN) were included. The primary tumor involved the hypopharynx (n=7), base of the tongue (n=10), nasopharynx (n=2) or upper esophagus (n=1) or its location was unknown (n=3). Treatment consisted of three cycles of chemotherapy (cisplatin 100mg/m2 on day 1; 5-FU 1,000mg/m2 per day for 5days as a continuous infusion, preceded by amifostine 910mg/m2), repeated every 3weeks. Uninterrupted concomitant boost-accelerated RT (total dose of 70Gy in 6weeks) started together on day 1 of the second cycle. All but two patients received the full course of RT. Eighteen patients achieved complete remission (78%). At a median follow-up of 45months the overall survival was 56% (95% c.i. 32-79%) and the loco-regional control 71% (95% c.i. 52-91%). Toxicity involved reversible renal insufficiency of ≥ grade II in 9 patients (39%) and neutropenic fever in 9 patients (39%). All patients suffered from moderate to severe mucositis (grade II/III), and 19 patients presented cutaneous toxicity grade III. Concomitant boost-accelerated RT combined with concurrent full-dose cisplatin/5-FU chemotherapy and amifostine is feasible with manageable, although substantial, toxicity. The overall survival of 4years is promising. Newer regimens causing less acute mucosal and skin toxicity are needed