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A prospective phase ii trial of concomitant chemotherapy and radiotherapy with delayed accelerated fractionation in unresectable tumors of the head and neck

✍ Scribed by Louis B. Harrison; Adam Raben; David G. Pfister; Michael Zelefsky; Elliot Strong; Jatin P. Shah; Ronald H. Spiro; Ashok Shaha; Dennis H. Kraus; Stimson P. Schantz; Elise Carper; Barbara Bodansky; Carol White; George Bosl

Publisher
John Wiley and Sons
Year
1998
Tongue
English
Weight
104 KB
Volume
20
Category
Article
ISSN
1043-3074

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✦ Synopsis

Background. Our study is a prospective evaluation of unresectable malignant cancers of the head and neck treated with concomitant chemotherapy and radiotherapy (RT) using delayed accelerated fractionation (concomitant boost).

Methods: Between January 1988 and March 1995, 82 patients with unresectable cancers of the head and neck were enrolled in this phase II study. Of these, 52 patients were treated and followed for a minimum of 3 years and are the subject of this analysis. All patients had T4 lesions and were stage IV according to the American Joint Committee on Staging Criteria (AJCC). Patients received RT with accelerated fractionation to a total of 70 Gy in 6 weeks using a concomitant-boost technique. Concomitant cis platin (100 mg/M 2 ) was given on days 1 and 22 of RT. Twenty-seven patients received mitomycin-C (7.5 mg/M 2 ) on days 1 and 22, and 1 patient received mitomycin-C on day 1. In addition, 27 patients received adjuvant chemotherapy with cis platin and vinblastine. The mean follow-up was 45 months (range, 36-72 months). The minimum follow-up for surviving patients is 3 years.

Results. At 3 years, the local control rate was 58%. Threeyear local control rates for paranasal sinus, nasopharynx, oropharynx, and larynx/hypopharynx were 78%, 78%, 64%, and 100%, respectively. For all patients, the distant-metastasis-free survival was 56%, and the overall survival rate was 36%. Patients with oral cavity cancers experienced worse overall survival versus other sites, 0% versus 47% (p = .03). Salivary cancers also showed worse survival versus other sites, 0% versus 47%, but was not statistically significant. Severe acute complications occurred in 34% of patients. Treatment-related toxicity also resulted in the death of 2 patients. Severe late complications occurred in 7% of patients.

Conclusions. Treatment of this poor prognostic group of patients with aggressive chemotherapy and RT produced surprisingly good local control and survival.

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The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.