Targeted chemoradiation for advanced head and neck cancer: analysis of 213 patients.
BACKGROUND
To determine the survival results, patterns of relapse, and organ preservation effects of a targeted chemoradiation protocol for patients with advanced (stage III-IV) carcinoma of the head and neck.


METHODS
Analysis of 213 patients with stage III-IV squamous cell carcinoma treated at UT Memphis between June 1993 and March 1998. Treatment included weekly intra-arterial infusions of cisplatin (150 mg/m(2)/ week x 4) rapidly delivered to the tumor bulk, simultaneous intravenous thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (180-200 cGy/fraction) to a total dose of 68-72 Gy.


RESULTS
Tumor response, toxicity, disease control above the clavicle, pattern of relapse, and survival. There were 89 events of grade III-IV toxicity and 6 treatment-related deaths (grade V). Complete response in the primary and regional sites was obtained in 171 of 213 (80%) and 92 of 151 (61%), respectively. The rate of clearance of regional disease after neck dissection was 98%. There were 51 of 195 recurrences (26%): 11 local (5.6%), 5 regional (2.6%), and 35 distant (17.9%). The Kaplan Meier plot projections for overall and cancer-related 5-year survival was 38.8% and 53.6%, respectively, whereas disease control above the clavicle was 74.3%.


CONCLUSIONS
We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer with a high rate of organ preservation and possibly improved survival.
Robbins
K T
KT
Department of Otolaryngology/Head and Neck Surgery, University of Tennessee, Memphis, College of Medicine, 956 Court Ave., Suite B226, Memphis, Tennessee, USA.
Kumar
P
P
Wong
F S
FS
Hartsell
W F
WF
Flick
P
P
Palmer
R
R
Weir
A B
AB
Neill
H B
HB
Murry
T
T
Ferguson
R
R
Hanchett
C
C
Vieira
F
F
Bush
A
A
Howell
S B
SB
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011838:Radiation-Sensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D015996:Survival Rate; D013885:Thiosulfates / Q000627:therapeutic use
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D013885:Thiosulfates; D002945:Cisplatin