title: Concomitant chemotherapy and split-course radiation for cure and preservation of speech and swallowing in head and neck cancer.
abstract: To assess the ability of simultaneous cisplatin, 5-Fluorouracil, and radiation to substitute for surgery and radiation in advanced head and neck cancer, we have retrospectively selected from our phase II study a subgroup of 29 patients having primary disease requiring either more than a hemiglossectomy or a laryngectomy for control. Patients included 22 with stage IV and 7 with stage III disease, 12 tongue, 10 hypopharynx, and 7 larynx primaries. The treatment consisted of concurrent cisplatin, 5-Fluorouracil, and split-course radiation every other week for a total of 7 cycles within 13 weeks. With a median follow-up of 5 years, 86% of patients had preservation of speech and/or swallowing function. Median survival was 45 months, with 14 (48%) patients currently alive and disease free, 11 (38%) dead from their cancer, and 4 (14%) dead of other causes. The overall failure rate was 38%. Advanced-stage presence of N3 nodal disease and fewer than 7 cycles of chemotherapy received were significantly associated with increasing failure rates. This program of concomitant cisplatin, 5-Fluorouracil, and radiation produced control rates quite competitive with surgery and radiation and is appropriate for definitive testing in a randomized trial.
authors.affiliation: Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
authors.forename: S M
authors.initials: SM
authors.lastname: Hirsch
authors.forename: D D
authors.initials: DD
authors.lastname: Caldarelli
authors.forename: J C
authors.initials: JC
authors.lastname: Hutchinson
authors.forename: L D
authors.initials: LD
authors.lastname: Holinger
authors.forename: A K
authors.initials: AK
authors.lastname: Murthy
authors.forename: J L
authors.initials: JL
authors.lastname: Showell
authors.forename: S G
authors.initials: SG
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003679:Deglutition; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D013060:Speech; D014062:Tongue Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil