Chemoradiation for advanced head and neck cancer: potential for improving results to match those of current treatment modalities for early-stage tumors--long-term results of hyperfractionated chemoradiation with carbogen breathing and anemia correction with erythropoietin.
OBJECTIVE
To attempt to improve results of chemoradiation for head and neck cancer.


METHODS
From March 1996 to April 2007, 98 patients with head and neck cancer (15 Stage III and 83 Stage IV) were treated with a twice-daily hyperfractionated schedule. Eleven patients presented with N0, 11 with N1, 13 with N2A, 17 with N2B, 24 with N2C, and 22 with N3. Each fraction of treatment consisted of 5 mg/m(2) of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m(2) of carboplatin plus 8050 cGy in 7 weeks. Anemia was corrected with erythropoietin.


RESULTS
Ninety-six patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Local toxicity remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Ninety-seven complete responses were achieved. After 11 years of follow-up (median, 81 months), actuarial locoregional control, cause-specific survival, overall survival, and nodal control rates at 5 and 10 years were, respectively, 83% and 83%, 68% and 68%, 57% and 55%, and 100% and 100%. Median follow-up of disease-free survivors was 80 months. No significant differences in survival were observed between the different subsites or between the pretreatment node status groups (N0 vs. N+, N0 vs. N1, N0 vs. N2A, N0 vs. N2B, N0 vs. N2C, and N0 vs. N3).


CONCLUSIONS
Improving results of chemoradiation for advanced head and neck cancer up to the level obtained with current treatments for early-stage tumors is a potentially reachable goal.
Villar
Alfonso
A
Instituto Madrileño de Oncologia (Grupo IMO), Instituto Oncologico del Sureste, Murcia, Spain. avillar@grupoimo.com
Martinez
Jose Carlos
JC
de Serdio
Jose Luis
JL
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002985:Clinical Protocols; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010100:Oxygen / Q000008:administration & dosage*; D011832:Radiation Injuries / Q000473:pathology; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*; D011994:Recombinant Proteins; D016879:Salvage Therapy
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D002245:Carbon Dioxide; C011700:carbogen; D016190:Carboplatin; D010100:Oxygen