title: Do we need 5-FU in addition to cisplatin for chemoradiation of locally advanced head-and-neck cancer?
abstract: To compare chemoradiation with cisplatin alone or cisplatin plus 5-FU for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN).
  
  
  
  The outcomes of 142 patients who received chemoradiation with cisplatin alone for locally advanced SCCHN were retrospectively compared to 170 patients who received cisplatin plus 5-fluorouracil (5-FU). The outcomes compared included loco-regional control (LRC), metastases-free survival (MFS), overall survival (OS) and adverse events.
  
  
  
  Although patients who received cisplatin alone had a significantly worse performance status, 81% of these patients completed planned chemotherapy compared to 73% of patients in the cisplatin plus 5-FU group (p=0.18). Radiotherapy breaks >1week were necessary in 14% and 23% of patients, respectively (p=0.09). The 5-year LRC rates were 69% after cisplatin alone and 68% after cisplatin plus 5-FU (p=0.71). The 5-year MFS rates were 72% and 62%, respectively (p=0.37), and 5-year OS rates were 60% and 45%, respectively (p=0.066). On multivariate analysis, cisplatin alone was significantly associated with improved OS (RR 1.35; 95%-CI 1.09-1.69; p=0.006). Nausea/vomiting, pneumonia/sepsis and late adverse events occurred more common in the cisplatin plus 5-FU group.
  
  
  
  Given the limitations of a retrospective study, chemoradiation with cisplatin alone appeared associated with fewer adverse events and better OS than with cisplatin plus 5-FU in patients with locally advanced SCCHN. Thus, 5-FU in addition to cisplatin may be omitted for these patients. A randomized trial is warranted to confirm these findings.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. Electronic address: Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
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, University Medical Center Eppendorf, Hamburg, Germany.
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Lübeck, Germany.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Hakim
authors.affiliation: Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D002294:Carcinoma, Squamous Cell; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: 5-Fluorouracil; Adverse events; Chemoradiation; Cisplatin; Locally advanced head-and-neck cancer; Treatment outcomes