A comparison of treatment outcomes by radiochemotherapy and postoperative radiotherapy in locally advanced squamous cell carcinomas of head and neck.
OBJECTIVE
To investigate the treatment outcomes by concomitant radiochemotherapy (CHEMORAD), and by surgery and postoperative radiotherapy (PORT) in patients with locally advanced head and neck cancers.


METHODS
A retrospective study included all patients with Stage III and IV (except T1-2 N1) diseases between 1989 and 2002 treated with CHEMORAD (163 patients) or PORT (424 patients) at the L'Hôtel-Dieu de Québec. Chemotherapy was realized with Cisplatin (DDP) 100 mg/m(2), d1, d23, and d45 during radiotherapy or weekly DDP 40 mg/m(2) for 6 weeks in case of patients with poor general condition. Neck dissection was performed if residual disease was diagnosed on CHEMORAD. For the PORT group, 410 patients had neck dissection before adjuvant treatment.


RESULTS
The 2-year loco-regional control was 82% for CHEMORAD, and 72% for PORT (P = 0.01). The 2-year disease-free survival was 72% for CHEMORAD, and 64% for PORT (P = 0.02). The results were further confirmed by a Cox proportional hazard model.


CONCLUSIONS
The results indicated that CHEMORAD is a better approach than PORT in the management of locally advanced head and neck cancers. Further randomized study will be needed to compare radical CHEMORAD with surgery plus adjuvant CHEMORAD to determine an appropriate treatment in the management of locally advanced head and neck squamous cell carcinomas.
Department of Radiation Oncology, L'Hôtel-Dieu de Québec, Québec, Canada. afortin@videotron.ca
André
A
Fortin
Richard
R
Caouette
Chang Shu
CS
Wang
Eric
E
Vigneault
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin