Postoperative chemoradiotherapy for high-risk head-and-neck squamous cell carcinoma.
OBJECTIVE
To describe the use of postoperative concurrent chemoradiotherapy, with either weekly cisplatin or carboplatin, for high-risk head-and-neck squamous cell carcinoma (HNSCC) in a single institutional setting.


METHODS
Between July 1999 and January 2003, 47 patients were treated with postoperative chemoradiotherapy.


RESULTS
Of the 47 patients, 41 (87%) had Stage III-IV disease. The predominant primary site was the oral cavity in 24 patients (51%), 27 had nodal disease with extracapsular extension, and 26 had positive or close mucosal margins (<5 mm). Ten patients had undergone resection of recurrent disease after previous surgery. Twenty-seven (57%) were treated with cisplatin, and the remaining patients received carboplatin because of contraindications to cisplatin. The median radiotherapy dose was 60 Gy (range, 50-66 Gy). Of the 47 patients, 45 (96%) completed at least four of the six planned doses of chemotherapy and 45 (96%) completed the planned course of radiotherapy. Nineteen patients (40%) had confluent mucositis, eight (17%) had Grade 3-4 hematologic toxicity, and four (9%) had febrile neutropenia. No treatment-related deaths occurred. The estimated 2-year locoregional control, progression-free survival, and overall survival rate was 73%, 56%, and 62%, respectively. Excluding the 10 patients with recurrence after previous surgery, the locoregional control, progression-free survival, and overall survival rate was 81%, 64%, and 71%, respectively. Five cases of Grade 3-4 late treatment-related sequelae developed.


CONCLUSIONS
Treatment with postoperative concurrent weekly cisplatin or carboplatin and radiotherapy was reasonably well tolerated. Acute and late toxicity was acceptable. The overall results achieved are comparable with the preliminary results of recent randomized trials. Patients treated after resection of recurrent disease (after previous surgery alone) fared worse than those treated at the initial resection.
Porceddu
Sandro V
SV
Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VC, Australia. Sandro_Porceddu@phealth.qld.gov
Campbell
Belinda
B
Rischin
Danny
D
Corry
June
J
Weih
LeAnn
L
Guerrieri
Mario
M
Grossi
Marissa
M
Peters
Lester J
LJ
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D015996:Survival Rate
D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin