Relationship between clinical factors and the incidence of toxicity after intra-arterial chemoradiation for head and neck cancer.
OBJECTIVE
Concomitant chemoradiation is more and more used for advanced head and neck cancer. It improves local control and survival compared to radiotherapy alone, but goes along with serious toxicity. This study was set up to determine the relationship between patient-, tumour- and treatment-related factors and acute/late toxicity after concomitant chemoradiation.


METHODS
One hundred and twenty-five consecutive patients with newly diagnosed inoperable stage III and IV head and neck cancer were enrolled for intra-arterial chemoradiation. There were 28 women (22%) and 97 men (78%) and the mean age was 55 years (range 30-80). One hundred and nine patients had stage IV disease (87%), 16 patients (13%) had stage III disease. Statistical analyses were performed to identify an association between factors and acute/late toxicity.


RESULTS
There were eight treatment-related deaths (6%). Severe acute toxicity (grade 3-4), mainly mucositis and dysphagia as categorized by the RTOG toxicity criteria, was recorded in 51% of the patients. Leucopenia (grade 3-4) occurred in 39% and aspiration pneumonia in 20% of patients. Tracheotomy was necessary in 15 (12%) patients. Neurological complications during treatment occurred in 3 (2%) patients. Severe late toxicity occurred in 34% of the patients. The most important of these were pneumonia (14%), osteoradionecrosis (9%) and swallowing problems with permanent percutaneous gastrostomy (20%). Statistical analysis did show a significant association between site and severe acute mucositis (p = 0.007), site and osteoradionecrosis (p = 0.014) and age and xerostomia (p = 0.004).


CONCLUSIONS
Chemoradiation is frequently associated with serious toxicity. Oral cavity tumours and older age are related to acute mucositis/osteoradionecrosis and xerostomia, respectively.
van den Broek
Guido B
GB
Department of Head and Neck Oncology and Surgery, Academic Medical Centre, Amsterdam, The Netherlands. g.vd.broek@nki.nl
Balm
Alfons J M
AJ
van den Brekel
Michiel W M
MW
Hauptmann
Michael
M
Schornagel
Jan H
JH
Rasch
Coen R N
CR
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D012971:Gold Sodium Thiosulfate / Q000009:adverse effects / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D015994:Incidence; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000453:epidemiology*; D013280:Stomatitis / Q000175:diagnosis / Q000453:epidemiology*; D016896:Treatment Outcome; D014987:Xerostomia / Q000175:diagnosis / Q000453:epidemiology*
D000970:Antineoplastic Agents; D012971:Gold Sodium Thiosulfate; D002945:Cisplatin