title: Preoperative chemotherapy-sensitized radiation therapy for cervical metastases in head and neck cancer.
abstract: OBJECTIVE
  To determine the efficacy of concurrent preoperative cisplatin chemotherapy and radiotherapy (CT/RT) for patients with advanced head and neck cancer and cervical metastatic disease.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  Eighty-eight patients with operable stage III and IV squamous cell carcinoma of the head and neck and palpable cervical lymphogenous metastases received preoperative concurrent CT/RT followed by planned neck dissection.
  
  
  METHODS
  All patients undergoing CT/RT received concomitant continuous infusions of cisplatin (20 mg/m2) on days 1 to 4 and 22 to 25 of CT/RT. Thirty-nine patients underwent single-fraction (1.8-Gy) radiotherapy to 45.0 Gy, and 49 patients received 10 single-fraction (1.8-Gy) treatments, which were hyperfractionated (1.2-Gy twice a day) to 46.8 Gy.
  
  
  METHODS
  The 71 patients for whom complete post-CT/RT data were available were evaluated for clinical response in addition to survival. Histologic complete response (HCR) was confirmed from planned neck dissection specimens (n = 48) after clinical complete response (CCR) from initial CT/RT. Kaplan-Meier statistical analysis for disease-specific survival and overall survival was performed on all 88 patients who received CT/RT.
  
  
  RESULTS
  A CCR and an HCR were noted in 78% (18/23) and 59% (10/17) of patients with N1 lesions, respectively, and in 60% (29/48) and 45% (14/31) of patients with N2-3 lesions, respectively. The percentage of patients with CCR who also had HCR was 67% (10/15) for patients with N1 lesions and 54% (14/26) for patients with N2-3 lesions. With a median follow-up of 18.5 months, the Kaplan-Meier disease-specific survival rate at 54 months (n = 88) was 70% (21/30) for patients with N1 lesions, 60% (24/40) for patients with N2 lesions, and 39% (7/18) for patients with N3 lesions. The overall survival and disease-specific survival rates at 5 years for all nodal groups combined were 36% (32/88) and 59% (52/88), respectively.
  
  
  CONCLUSIONS
  A CCR to CT/RT was achieved in nearly two thirds of patients with head and neck cervical lymphogenous metastases, independent of nodal tumor load. Most patients (59% [24/41]) with CCR were pathologically tumor free before neck dissection.
authors.affiliation: Department of Surgery, Cooper Hospital--University Medical Center, University of Medicine & Dentistry of New Jersey--Robert Wood Johnson Medical School, Camden 08103, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Puc
authors.forename: F A
authors.initials: FA
authors.lastname: Chrzanowski
authors.forename: H S
authors.initials: HS
authors.lastname: Tran
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.forename: A S
authors.initials: AS
authors.lastname: Glicksman
authors.forename: C
authors.initials: C
authors.lastname: Landman
authors.forename: G J
authors.initials: GJ
authors.lastname: Slotman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D011838:Radiation-Sensitizing Agents; D002945:Cisplatin