Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers

  • Lasrado, Savita (Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College) ;
  • Moras, Kuldeep (Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College) ;
  • Pinto, George Jawahar Oliver (Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College) ;
  • Bhat, Mahesh (Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College) ;
  • Hegde, Sanath (Indian Institute of Oncology) ;
  • Sathian, Brijesh (Department of Community Medicine, Manipal College of Medical Sciences) ;
  • Luis, Neil Aaron (Dental Surgeon in Private Practice)
  • Published : 2014.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

Keywords

References

  1. Al-Sarraf M (1988). Head and neck cancer: chemotherapy concepts. Semin Oncol, 15, 70-85.
  2. Baykara M, Buyukberber S, Ozturk B, et al (2013). Efficacy and safety of concomitant chemoradiotherapy with cisplatin and docetaxel in patients with locally advanced squamous cell head and neck cancers. Asian Pac J Cancer Prev, 14, 2557-61. https://doi.org/10.7314/APJCP.2013.14.4.2557
  3. Bertino G, Occhini A, Falco CE, et al (2009).Concurrent intraarterial carboplatin administration and radiation therapy for treatment of advanced head and neck squamous cell carcinoma: short term results. BMC Cancer, 9, 313. https://doi.org/10.1186/1471-2407-9-313
  4. Calais G, Alfonsi M, Bardet E, et al (1999). Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced stage oropharynx carcinoma. J Natl Cancer Inst, 91, 2081-6. https://doi.org/10.1093/jnci/91.24.2081
  5. Calcattera TC, Juillard GJ (1995). Oral cavity and hypopharynxhead and neck cancer. In: Haskell CM, Berek JS, editors. Cancer Treatment. WB Saunders Co:Philadelphia, .p.726-732.
  6. Denis F, Garaud P, Bardet E, et al (2004). Final results of the 94-01 French head and neck oncology and radiotherapy group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced stage oropharynx carcinoma. J Clin Oncol, 22, 69-76.
  7. Dinshaw KA, Rao DN, Ganesh B (2000). Hospital based cancer registry, annual report, Tata Memorial Hospital, Mumbai, India.
  8. Eisenberger M, Sinibaldi V, Jacobs M, Gray W (1988). Simultaneous treatment with carboplatin (NSC-241-240) and radiotherapy in advanced unresectable squamous cell carcinomas of the head and neck. Cancer Treat Rev, 1988, 3-7.
  9. Haddad R, O'Neill A, Rabinowits G, et al (2013). Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol, 14, 257-64. https://doi.org/10.1016/S1470-2045(13)70011-1
  10. Herman LC, Chen L, Garnett A, et al (2014). Comparison of carboplatin-paclitaxel to docetaxel-cisplatin-5-flurouracil induction chemotherapy followed by concurrent chemoradiation for locally advanced head and neck cancer. Oral Oncol, 50, 52-8. https://doi.org/10.1016/j.oraloncology.2013.08.007
  11. Hosokawa Y, Kamada T, Shirato H, et al (1995). Simultaneous carboplatin and radiotherapy for all stages of head and neck squamous cell carcinoma. Clin Oncol, 7, 168-72. https://doi.org/10.1016/S0936-6555(05)80510-2
  12. Mabanta SR, Mendenhall WM, Stringer SP, Cassisi NJ (1999). Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinomawith clinically positive neck nodes. Head Neck, 21, 591-4 https://doi.org/10.1002/(SICI)1097-0347(199910)21:7<591::AID-HED1>3.0.CO;2-Y
  13. Nam EJ, Lee M, Yim GA, et al (2013). Comparison of carboplatinand cisplatin-based concurrent chemoradiotherapy in locally advanced cervical cancer patients with morbidity risks. Oncologist, 18, 843-9. https://doi.org/10.1634/theoncologist.2012-0455
  14. Nguyen NP, Vos P, Smith HJ, et al (2007). Concurrent chemoradiation for locally advanced oropharyngeal cancer. Am J Otolaryngol, 28, 3-8. https://doi.org/10.1016/j.amjoto.2006.03.007
  15. Okami K, Hamano T, Takeo T, Sugimoto R, Sekine M (2007). A survey of head and neck malignancy at Tokai University Hospital. Tokai J Exp Clin Med, 32, 62-6.
  16. Pignon JP, Bourhis J, Domenge C, Designe L (2000). Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta. analyses of updated individual data. Lancet, 355, 949-55. https://doi.org/10.1016/S0140-6736(00)90011-4
  17. Robert JK, Benjamin GW, Cleveland OH, et al (1988). Squamous cell carcinoma of head and neck in patients 40 years of age and younger. Laryngocsope, 531-3.
  18. Seiwert TY, Salama JK, Vokes EE (2007). The concurrent chemoradiation paradigm-general principles. Nat Clin Pract Oncol, 4, 86-100. https://doi.org/10.1038/ncponc0714
  19. Shah JP, Ladd W (1995). Treatment of cancer of the head and neck. CA Cancer J Clin, 45, 352-68. https://doi.org/10.3322/canjclin.45.6.352
  20. Taguchi T, Tsukuda M, Mikami Y, et al (2009). Treatment results and prognostic factors for advanced squamous cell carcinoma of the head and neck treated with concurrent chemoradiotherapy. Auris Nasus Larynx, 36, 199-204. https://doi.org/10.1016/j.anl.2008.04.003
  21. Takiar R, Nadayil d, Nandakumar A (2010). Projections of number of cancer cases in India (2010-2020) by cancer groups. Asian Pac J Cancer Prev, 11, 1045-9.
  22. Vokes EE, Weichselbaum RR, Lippman SM, Hong WK (1993). Head and neck cancer. N Engl J Med, 328, 184-94. https://doi.org/10.1056/NEJM199301213280306
  23. Yang LX, Douple E, Wang HJ (1995). Irradiation- enhanced binding of carboplatin to DNA. Int J Radiat Biol, 68, 609-614. https://doi.org/10.1080/09553009514551611
  24. Zhu WG, Zhou K, Yu CH, et al (2012). Efficacy analysis of simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with neck and upper thoracic esophageal carcinoma.. Asian Pac J Cancer Prev, 13, 803-7. https://doi.org/10.7314/APJCP.2012.13.3.803

Cited by

  1. Novel DOX-MTX Nanoparticles Improve Oral SCC Clinical Outcome by Down Regulation of Lymph Dissemination Factor VEGF-C Expression in vivo: Oral and IV Modalities vol.15, pp.15, 2014, https://doi.org/10.7314/APJCP.2014.15.15.6227
  2. DOX-MTX-NPs Augment p53 mRNA Expression in OSCC Model in Rat: Effects of IV and Oral Routes vol.15, pp.19, 2014, https://doi.org/10.7314/APJCP.2014.15.19.8377
  3. New formulated "DOX-MTX-loaded Nanoparticles" Down-regulate HER2 Gene Expression and Improve the Clinical Outcome in OSCCs Model in Rat: the Effect of IV and Oral Modalities vol.15, pp.21, 2014, https://doi.org/10.7314/APJCP.2014.15.21.9355
  4. Competing Causes of Death in 138 Patients with Loco-Regionally Advanced Head and Neck Cancer Treated with Multi-Modality Treatment vol.06, pp.05, 2015, https://doi.org/10.4236/jct.2015.65045
  5. Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India vol.15, pp.24, 2015, https://doi.org/10.7314/APJCP.2014.15.24.10867
  6. Radiotherapy and Concurrent Chemo-Radiotherapy in Locally Advanced Hypopharyngeal Cancers - A Hospital Registry Based Analysis vol.16, pp.11, 2015, https://doi.org/10.7314/APJCP.2015.16.11.4723
  7. Weekly Cisplatin-Based Concurrent Chemoradiotherapy for Treatment of Locally Advanced Head and Neck Cancer: a Single Institution Study vol.16, pp.16, 2015, https://doi.org/10.7314/APJCP.2015.16.16.7309
  8. Concurrent Chemoradiation with Weekly Cisplatin for the Treatment of Head and Neck Cancers: an Institutional Study on Acute Toxicity and Response to Treatment vol.16, pp.16, 2015, https://doi.org/10.7314/APJCP.2015.16.16.7331
  9. Survival in Head and Neck Cancers - Results of A Multi-Institution Study vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1745