title: Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic.
abstract: OBJECTIVE
  To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer.
  
  
  METHODS
  Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients.
  
  
  RESULTS
  Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients.
  
  
  CONCLUSIONS
  This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.
authors.affiliation: Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. h.rutten@rther.umcn.nl
authors.forename: Heidi
authors.initials: H
authors.lastname: Rütten
authors.forename: Lucas A M
authors.initials: LA
authors.lastname: Pop
authors.forename: Geert O R J
authors.initials: GO
authors.lastname: Janssens
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.forename: Simone
authors.initials: S
authors.lastname: Knuijt
authors.forename: Antoinette F
authors.initials: AF
authors.lastname: Rooijakkers
authors.forename: Manon
authors.initials: M
authors.lastname: van den Berg
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Merkx
authors.forename: Carla M L
authors.initials: CM
authors.lastname: van Herpen
authors.forename: Johannes H A M
authors.initials: JH
authors.lastname: Kaanders
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003404:Creatinine; D002945:Cisplatin