title: Feasibility study of moderately accelerated intensity-modulated radiotherapy plus concurrent weekly cisplatin after induction chemotherapy in locally advanced head-and neck cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC).
  
  
  METHODS
  Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m(2) plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas.
  
  
  RESULTS
  In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively.
  
  
  CONCLUSIONS
  In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.
authors.affiliation: Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Samantha
authors.initials: S
authors.lastname: Mignogna
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Mariangela
authors.initials: M
authors.lastname: Massaccesi
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.forename: Franco
authors.initials: F
authors.lastname: Calista
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serafini
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesú
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Picardi
authors.forename: Luciana
authors.initials: L
authors.lastname: Caravatta
authors.forename: Liberato
authors.initials: L
authors.lastname: Di Lullo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Giglio
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Sallustio
authors.forename: Angelo
authors.initials: A
authors.lastname: Piermattei
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012074:Remission Induction / Q000379:methods; D016879:Salvage Therapy; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil