Lack of evidence for a role of chemotherapy in the routine management of locally advanced head and neck cancer.

1986 ◽  
Vol 4 (7) ◽  
pp. 1121-1126 ◽  
Author(s):  
I F Tannock ◽  
G Browman
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Local Treatment ◽  
Poor Performance ◽  
High Rate ◽  
Poor Performance Status ◽  
Pilot Studies

Numerous single-arm studies have shown that chemotherapy may produce a high rate of response and rapid shrinkage of tumor when used before radiation and/or surgery in patients with squamous-cell carcinoma of the head and neck. Despite this high rate of tumor response, randomized controlled trials do not indicate any consistent improvement in survival for patients receiving chemotherapy as compared with patients receiving local treatment alone. This population of patients often has poor performance status, and chemotherapy invariable adds some toxicity. Also, studies in animals suggest that some types of chemotherapy given before local radiation or surgery might increase the probability of distant metastases. Apart from pilot studies of feasibility, all future trials of chemotherapy should involve a randomized comparison with a group of patients receiving radiation and/or surgery alone. At present, chemotherapy has no place in the routine management of primary head and neck cancer.

Neoadjuvant and adjuvant methotrexate, cisplatin, and fluorouracil in multimodal therapy of head and neck cancer.

1989 ◽  
Vol 7 (7) ◽  
pp. 838-845 ◽  
Author(s):  
E E Vokes ◽  
W J Moran ◽  
R Mick ◽  
R R Weichselbaum ◽  
W R Panje
Keyword(s):  
Head And Neck Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Head And Neck ◽  
Continuous Infusion ◽  
Neck Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Local Therapy ◽  
Stage Iv

To increase the complete response (CR) rate of patients with locally advanced head and neck cancer after three cycles of neoadjuvant chemotherapy, we added sequential methotrexate to the combination of cisplatin and continuous infusion fluorouracil (5-FU). We also evaluated the feasibility of administering three additional cycles of the same regimen as adjuvant chemotherapy. Thirty-eight patients were treated; the median age was 53 years and 36 patients had stage IV disease. Chemotherapy consisted of methotrexate 120 mg/m2 followed 24 hours later by cisplatin 100 mg/m2 and a five-day continuous infusion of 5-FU at 1,000 mg/m2/d. Of 34 patients evaluable for response to neoadjuvant chemotherapy, nine had a CR, 21 a partial response (PR), two a minimal response (MR), and one patient each stable disease (SD) and no response (NR). Of 31 patients who received local therapy, 15 were treated with surgery and radiotherapy and 16 with radiotherapy alone. Of 25 patients eligible to receive adjuvant chemotherapy only ten received all three intended cycles, while 15 received less or no adjuvant chemotherapy because of patient refusal, cumulative toxicity, or early disease progression. With a median follow-up time of 39 months, the median survival is estimated to be 20 months. Of eight patients with nasopharyngeal or paranasal sinus cancer, none has had disease recurrence. Patients with good initial performance status and low N-stage also had a significant survival advantage. Chemotherapy-related toxicities consisted mainly of mucositis, requiring 5-FU dose reduction in the majority of patients; similar toxicities were exacerbated in the adjuvant setting. The addition of methotrexate did not increase the CR rate over what has been reported for the combination of cisplatin and 5-FU alone. Certain subsets of patients appear to have a good prognosis when treated in this fashion. The administration of adequate adjuvant chemotherapy in patients with head and neck cancer remains difficult due to toxicity and poor patient compliance.

Impact of age on treatment effect in locally advanced head and neck cancer (HNC): Two individual patient data meta-analyses

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5501-5501 ◽  
Author(s):  
J. Bourhis ◽  
A. Le Maı̂tre ◽  
J. Pignon ◽  
K. Ang ◽  
J. Bernier ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Effect ◽  
Cox Model ◽  
Meta Analysis ◽  
Performance Status ◽  
Locally Advanced ◽  
Risk Of Death

5501 Background: The Meta-Analysis of Radiotherapy in Carcinomas of Head & Neck (MARCH; Bourhis J, ASTRO 2002) showed that altered fractionation radiotherapy (Alt-RT) could improve survival as compared to standard RT in patients with locally advanced HNC (pooled hazard ratio - HR -: 0.92, 95% confidence interval: 0.86–0.97). The Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC; Bourhis J, ASCO 2004) demonstrated that concomitant chemotherapy (CT), added to RT, improved survival (HR: 0.82, 95% CI: 0.78–0.86). This study considers age as a potential modifier of the treatment effect. Methods: 15 randomized trials with 6,515 patients were included in MARCH (median follow up: 6.0 years), and 50 with 9,471 patients in concomitant part of MACH-NC (median follow up: 5.6 years). The interaction between age and treatment effect, using HR of death, was tested with heterogeneity test. Effect of prognostic factors on the interaction was analysed using Cox model. Results: The effect of Alt-RT in MARCH and of concomitant CT in MACH-NC on overall survival decreased with increased age ( table ). Patients aged 71+ had a lower performance status, less advanced stage, and more often laryngeal cancer than the younger patients; there were more women in the oldest patients group. However, adjusting on covariates did not modify the results. Causes of death was available in MARCH and in recent (1994–2000) trials of MACH-NC. The proportion of deaths not due to HNC increased with age, from 18% at age 50 to 41% at age 71+ in MARCH, and from 15% to 39% in MACH-NC. Conclusions: Treatment benefit decreases with increasing age. Patients aged 71+ did not benefit from Alt- RT nor from concomitant CT. The increasing risk of death from other causes with age may explain part of these observations. Supported by PHRC, ARC, LNCC [Table: see text] No significant financial relationships to disclose.

Radiation and Concurrent Carboplatin Administration in Locally Advanced Head and Neck Cancer

1995 ◽  
Vol 81 (5) ◽  
pp. 354-358 ◽  
Author(s):  
◽  
George Fountzilas ◽  
Dimosthenis Skarlos ◽  
Angelos Nikolaou ◽  
Anna Kalogera-Fountzila ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Dose Intensity ◽  
Phase Iii ◽  
Concurrent Administration ◽  
Grade 3

Aims and Background To improve local control in patients with locally advanced inoperable head and neck cancer we administered carboplatin concurrently with radiation. Methods Thirty-nine patients entered the study. There were 35 men and 4 women with a median age of 58 years (range, 24-74) and a median performance status of 90 (range, 60-100) of the Karnofsky scale. The primary site included nasopharynx (5 patients), oropharynx (n=10), hypopharynx (n=5), larynx (n=12), oral cavity (n=2), paranasal sinuses (n=3), salivary glands (n=1) and unknown (n=1). Histology was squamous cell carcinoma in all cases. All patients were irradiated with a 60Co unit. According to the protocol, they should receive 66-70 Gy to the tumor area and 45 Gy to the tumor-free area of the neck. Carboplatin was administered at a dose of 400 mg/m2 on days 2, 22 and 42. Results Totally, 112 cycles of carboplatin were administered, of which 106 (95%) were at full dose. Median dose intensity of carboplatin actually delivered was 170 mg/m2/week (range, 57-200). All patients were irradiated, although only 30 (77%) received >66 Gy. After the completion of combined treatment, 23 (59%, 95% C.I. 42-74%) achieved a CR and 10 (26%, 95% C.I. 13-42%) a PR. Grade 3-4 myelotoxicity was noticed in 60% of the patients. Other grade 3-4 toxicities included stomatitis (13%), dysphagia (5%) and weight loss (3%). Median time to progression was 18 months (range, 2-25). Conclusions Radiation and concurrent administration of carboplatin determined a high CR rate in patients with HNC, although the superiority of this combined modality approach over radiation alone has to be proven in phase III trials.

scholarly journals Oligometastatic head and neck cancer: Which patients benefit from radical local treatment of all tumour sites?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Thomas Weissmann ◽  
Daniel Höfler ◽  
Markus Hecht ◽  
Sabine Semrau ◽  
Marlen Haderlein ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Local Treatment ◽  
Distant Metastases ◽  
Tumour Volume ◽  
The Impact ◽  
Total Tumour Volume

Abstract Background There is a large lack of evidence for optimal treatment in oligometastatic head and neck cancer and it is especially unclear which patients benefit from radical local treatment of all tumour sites. Methods 40 patients with newly diagnosed oligometastatic head and neck cancer received radical local treatment of all tumour sites from 14.02.2008 to 24.08.2018. Primary endpoint was overall survival. Time to occurrence of new distant metastases and local control were evaluated as secondary endpoints as well as prognostic factors in univariate und multivariate Cox’s regression analysis. To investigate the impact of total tumour volume on survival, all tumour sites were segmented on baseline imaging. Results Radical local treatment included radiotherapy in 90% of patients, surgery in 25% and radiofrequency ablation in 3%. Median overall survival from first diagnosis of oligometastatic disease was 23.0 months, 2-year survival was 48%, 3-year survival was 37%, 4-year survival was 24% and 5-year survival was 16%. Median time to occurrence of new distant metastases was 11.6 months with freedom from new metastases showing a tail pattern after 3 years of follow-up (22% at 3, 4- and 5-years post-treatment). In multivariate analysis, better ECOG status, absence of bone and brain metastases and lower total tumour volume were significantly associated with improved survival, whereas the number of metastases and involved organ sites was not. Conclusions Radical local treatment in oligometastatic head and neck cancer shows promising outcomes and needs to be further pursued. Patients with good performance status, absence of brain and bone metastases and low total tumour volume were identified as optimal candidates for radical local treatment in oligometastatic head and neck cancer and should be considered for selection in future prospective trials.

Radiation Concurrent With Gemcitabine for Locally Advanced Head and Neck Cancer: A Phase I Trial and Intracellular Drug Incorporation Study

2001 ◽  
Vol 19 (3) ◽  
pp. 792-799 ◽  
Author(s):  
Avraham Eisbruch ◽  
Donna S. Shewach ◽  
Carol R. Bradford ◽  
James F. Littles ◽  
Theodore N. Teknos ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Low Dose ◽  
Tumor Response ◽  
Locally Advanced ◽  
High Rate ◽  
Advanced Head ◽  
Dose Levels ◽  
Complete Tumor

PURPOSE: To examine the feasibility and dose-limiting toxicity (DLT) of once-weekly gemcitabine at doses predicted in preclinical studies to produce radiosensitization, concurrent with a standard course of radiation for locally advanced head and neck cancer. Tumor incorporation of gemcitabine triphosphate (dFdCTP) was measured to assess whether adequate concentrations were achieved at each dose level. PATIENTS AND METHODS: Twenty-nine patients with unresectable head and neck cancer received a course of radiation (70 Gy over 7 weeks, 5 days weekly) concurrent with weekly infusions of low-dose gemcitabine. Tumor biopsies were performed after the first gemcitabine infusion (before radiation started), and the intracellular concentrations of dFdCTP were measured. RESULTS: Severe acute and late mucosal and pharyngeal-related DLT required de-escalation of gemcitabine dose in successive patient cohorts receiving dose levels of 300 mg/m2/wk, 150 mg/m2/wk, and 50 mg/m2/wk. No DLT was observed at 10 mg/m2/wk. The rate of endoscopy- and biopsy-assessed complete tumor response was 66% to 87% in the various cohorts. Tumor dFdCTP levels were similar in patients receiving 50 to 300 mg/m2 (on average, 1.55 pmol/mg, SD 1.15) but were barely or not detectable at 10 mg/m2. CONCLUSION: A high rate of acute and late mucosa-related DLT and a high rate of complete tumor response were observed in this regimen at the dose levels of 50 to 300 mg/m2, which also resulted in similar, subcytotoxic intracellular dFdCTP concentrations. These results demonstrate significant tumor and normal tissue radiosensitization by low-dose gemcitabine. Different regimens of combined radiation and gemcitabine should be evaluated, based on newer preclinical data promising an improved therapeutic ratio.

Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment

2009 ◽  
Vol 18 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Giorgio Capuano ◽  
Pier Carlo Gentile ◽  
Federico Bianciardi ◽  
Michela Tosti ◽  
Anna Palladino ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Advanced Head ◽  
And Performance

scholarly journals Institutional Clinical Trial Accrual Volume and Survival of Patients With Head and Neck Cancer

2015 ◽  
Vol 33 (2) ◽  
pp. 156-164 ◽  
Author(s):  
Evan J. Wuthrick ◽  
Qiang Zhang ◽  
Mitchell Machtay ◽  
David I. Rosenthal ◽  
Phuc Felix Nguyen-Tan ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Performance Status ◽  
Locally Advanced ◽  
Radiation Therapy Oncology Group ◽  
Cox Proportional Hazards ◽  
Institutional Experience

Purpose National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown. Patients and Methods The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models. Results Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment. Conclusion OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC.

S165 – Locally Advanced Head and Neck Cancer Treatment Patterns

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P131-P131
Author(s):  
Wildon R Farwell ◽  
Elizabeth Lawler ◽  
Subha Chittamooru ◽  
Marc F Botteman
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Tumor Staging ◽  
Performance Status ◽  
Locally Advanced ◽  
High Dose ◽  
Advanced Head ◽  
Performance Score ◽  
Platinum Based Chemotherapy

Objectives We assessed the extent of chemoradiation therapy (CRT) or high-dose platinum-based chemotherapy plus radiation (P-CRT) initiation for patients with stage III/IV, locally advanced head and neck cancer (LAHNC) treated in the VA New England Healthcare System (VA-NEHS), and identified the factors associated with such initiation. Methods Newly diagnosed LAHNC patients treated in the VA-NEHS (from 1996 to 2006) were identified from electronic records. Patients’ tumor staging (TNM), demographics, performance score, comorbidities, alcohol and tobacco use or dependence, and diagnosis year were abstracted via chart review. The primary outcome was the initial treatment strategy, grouped as CRT ± surgery (including P-CRT), chemotherapy (CT) ± surgery, radiation therapy (RT) ± surgery, surgery alone, or no treatment. Multiple logistic regressions compared odds of failure to initiate CRT or P-CRT across the aforementioned patient characteristics. Results Of 496 patients identified, 34.5%, 34.7%, 6.7%, and 5.4% initiated CRT, RT, CT, and surgery alone, respectively, whereas 18.8% were untreated. Most patients initiating CRT (59.7%) or CT (51.5%) received platinum-based chemotherapy. Predictors of failure to initiate CRT included diagnosis year 2002 (OR=3.57, 95% CI: 2.32, 5.55), age >65 years old (OR=2.47, 95% CI: 1.55, 3.92), performance score <90 (OR=2.27, 95% CI: 1.43, 3.59), and past/present alcohol use (OR=1.95, 95% CI: 1.08, 3.52). Similar factors predicted failure to initiate P-CRT. Conclusions Although CRT/P-CRT initiation increased over time, older patients, patients with poorer performance status, and those using alcohol were less likely to initiate CRT. Research is needed to describe treatment outcomes in LAHNC patients not initiating CRT/P-CRT.

Sign in / Sign up

Export Citation Format

Share Document