title: Alternating chemotherapy: gemcitabine and cisplatin with concurrent radiotherapy for treatment of advanced head and neck cancer.
abstract: BACKGROUND
  Many studies have shown gemcitabine and cisplatin are radiosensitizers. Concurrent chemoradiation seems to be an efficient approach for treatment of advanced head and neck cancer (HNC), but toxicity is significant.
  
  
  OBJECTIVE
  To evaluate safety and explore efficacy of alternating chemotherapy with gemcitabine and cisplatin concurrent with radiotherapy in patients with advanced non-metastatic HNC.
  
  
  METHODS
  Twenty-eight patients diagnosed with advanced Squamous Cell Carcinomas of the Head and Neck (SCCHN) in stages III (28%), IVa (36%), and IVb (36%) were treated with gemcitabine: 100mg/m(2) alternating with cisplatin: 50mg/m(2) concurrent with radiotherapy at doses of 2 Gy/day until completing 70 Gy. While awaiting for concurrent treatment, eleven patients received induction chemotherapy with cisplatin: 100mg/m(2) and 5-FU: 1000 mg/m(2). Toxicity, especially in relation to mucositis, xerostomy, dysphagia, leucopenia and radiodermitis was evaluated.
  
  
  RESULTS
  5-year progression-free survival was 27.8 ± 17.2% (CI-95: 0-61.5) and overall survival was 55.9 ± 11% (CI: 34.4-77.5). Overall response rate was 93%; complete response was 64.3% and partial response was 28.6%. Extensive surgery for primary site was avoided in 19 patients (70.4%). Grade 3-4 adverse events were mucositis (46.4%), leucopenia (14.2%), dysphagia (25%), xerostomy (10.7%) and radiodermitis (3.6%). Response rates and toxicity were not significantly different among those patients with and without induction chemotherapy, but survival was higher in patients receiving induction.
  
  
  CONCLUSIONS
  Gemcitabine alternating with cisplatin concurrent with radiotherapy is an active and safe treatment that deserves further study.
authors.affiliation: Department of Medical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico. oncoincan@hotmail.com
authors.forename: J L
authors.initials: JL
authors.lastname: Aguilar-Ponce
authors.forename: M
authors.initials: M
authors.lastname: Granados-García
authors.forename: J C
authors.initials: JC
authors.lastname: Cruz López
authors.forename: F
authors.initials: F
authors.lastname: Maldonado-Magos
authors.forename: M A
authors.initials: MA
authors.lastname: Alvarez-Avitia
authors.forename: O
authors.initials: O
authors.lastname: Arrieta
authors.forename: I
authors.initials: I
authors.lastname: González-Ramírez
authors.forename: G
authors.initials: G
authors.lastname: Lara-Cruz
authors.forename: I
authors.initials: I
authors.lastname: Martinez-Juárez
authors.forename: R
authors.initials: R
authors.lastname: Medina-Santillan
authors.forename: C
authors.initials: C
authors.lastname: Castillo-Hernández
authors.forename: J
authors.initials: J
authors.lastname: De la Garza-Salazar
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000139:chemically induced; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use*; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012449:Safety; D013280:Stomatitis / Q000139:chemically induced; D015996:Survival Rate; D016896:Treatment Outcome; D014987:Xerostomia / Q000139:chemically induced; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine