title: Importance of Chemotherapy and Radiation Dose After Microscopically Incomplete Resection of Stage III/IV Head and Neck Cancer.
abstract: OBJECTIVE
  To investigate the importance of chemotherapy and radiation dose after R1 resection of squamous cell carcinoma of the head-and-neck (SCCHN).
  
  
  METHODS
  One hundred and twenty-two patients receiving radiotherapy alone or with concurrent chemotherapy [cisplatin or cisplatin/5-fluorouracil (5-FU)] were retrospectively analyzed.
  
  
  RESULTS
  On multivariate analysis, chemotherapy was significantly associated with improved locoregional control (p=0.048). Three-year locoregional control rates were 61% for those treated without chemotherapy, 83% for those treated with cisplatin and 77% for those treated with cisplatin/5-FU. Radiation doses of 66 and 70 Gy were non-significantly superior to 60-64 Gy (p=0.18). On multivariate analysis, chemotherapy showed a trend for improving survival (p=0.055). Three-year OS rates were 51% for those without chemotherapy, 65% for those treated with cisplatin and 57% for those treated with cisplatin/5-FU. Radiation doses of 66 Gy (3-year survival=61%) and 70 Gy (70%) were superior to 60-64 Gy (25%) (p=0.021).
  
  
  CONCLUSIONS
  Concurrent chemotherapy and a radiation dose of 66 Gy resulted in better outcomes. Cisplatin and cisplatin/5-FU were similarly effective. Radiation doses >66 Gy appear not to be necessary.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seidl
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Oral and Maxillofacial Surgery and Oto-Rhino-Laryngology, University of Lübeck, Lübeck, Germany.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Hakim
authors.affiliation: Department of Head and Neck Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany rades.dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Head-and-neck cancer; completion of treatment; microscopically incomplete resection; palliative radiation therapy; radiation dose; survival