title: Combined concomitant boost radiotherapy and chemotherapy in stage III-IV head and neck carcinomas: a comparison of toxicity and treatment results with those observed after radiotherapy alone.
abstract: BACKGROUND
  Alteration of radiation therapy (RT) fractionation and the combination of chemotherapy (CT) with RT represent two predominant fields of current research in the treatment of head and neck carcinomas. To assess the potential integration of these two fields, a retrospective comparison of toxicity and treatment outcome was carried out in stage III-IV patients treated with a concomitant boost RT schedule with or without CT.
  
  
  METHODS
  Fifty-two patients were treated by RT alone and 35 by RT and CT. In the RT group, there were significantly fewer T3-4 tumors (56% vs. 88%, P = 0.002) and higher proportion of planned neck dissections (35% vs. 14%, P = 0.047). The planned total dose was 69.9 Gy delivered over 5.5 weeks. In 10 cases CT was given before RT and in 25 concomitantly with RT, either alone or with neoadjuvant and/ or adjuvant CT. All patients but two had cisplatin-based (CDDP, 100 mg/m2) CT, associated in 28 patients with 5-fluorouracil (5-FU, 1000 mg/m2/24 h x 5). The median follow-up for the surviving patients was 21 and 31 months for the RT and RT-CT groups respectively.
  
  
  RESULTS
  Grade 3-4 acute toxicity (RTOG) was observed in 73% and 36% of patients, and grade 3 dysphagia in 31% and 57% (P = 0.02) respectively in the RT and RT-CT groups. The rates of grade 3-4 late complications were similar in the two groups (5% vs. 12%). At three years, actuarial loco-regional control (LRC) was 57% and 66% (P = 0.66) and overall survival was 56% and 47% (P = 0.99) in the RT and RT-CT groups respectively.
  
  
  CONCLUSIONS
  While acute toxicity was higher compared with RT alone, this accelerated RT schedule was feasible in association with 5-FU/CDDP, even administered concomitantly. Despite the significant proportion of more advanced disease in the RT-CT group, LRC was similar to that obtained by RT alone. Combinations of concomitant boost RT and chemotherapy merit further investigation in prospective trials.
authors.affiliation: Division of Radiation Oncology, University Hospital, Geneva, Switzerland.
authors.forename: A S
authors.initials: AS
authors.lastname: Allal
authors.forename: S
authors.initials: S
authors.lastname: Bieri
authors.forename: R
authors.initials: R
authors.lastname: Miralbell
authors.forename: P
authors.initials: P
authors.lastname: Dulguerov
authors.forename: A
authors.initials: A
authors.lastname: Bardina
authors.forename: W
authors.initials: W
authors.lastname: Lehmann
authors.forename: J M
authors.initials: JM
authors.lastname: Kurtz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil