Preoperative chemoradiation directed by primary site rebiopsy in stage III/IV squamous head and neck cancer is associated with high rate of local regional control, but is still plagued by long-term distant failure

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 5549-5549
Author(s):  
H. J. Wanebo ◽  
P. Chougule ◽  
N. Ready ◽  
R. J. Koness ◽  
R. McRae ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Preoperative Chemoradiation ◽  
Primary Site ◽  
High Rate ◽  
Regional Control ◽  
Distant Failure ◽  
Local Regional Control

Hemoglobin levels predict local regional control after postoperative radiotherapy for advanced head and neck cancer

1997 ◽  
Vol 33 ◽  
pp. S102-S103 ◽  
Author(s):  
R. Guttenberger ◽  
J. Lutterbach ◽  
A. Roth ◽  
S. Rõser ◽  
R. Schindler ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Postoperative Radiotherapy ◽  
Advanced Head ◽  
Regional Control ◽  
Local Regional Control

Multiagent Concurrent Chemoradiotherapy for Locoregionally Advanced Squamous Cell Head and Neck Cancer: Mature Results From a Single Institution

2006 ◽  
Vol 24 (7) ◽  
pp. 1064-1071 ◽  
Author(s):  
David J. Adelstein ◽  
Jerrold P. Saxton ◽  
Lisa A. Rybicki ◽  
Ramon M. Esclamado ◽  
Benjamin G. Wood ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Organ Preservation ◽  
Primary Site ◽  
Overall Survival Rate ◽  
Regional Control

Purpose A retrospective review with long-term follow-up is reported from the Cleveland Clinic Foundation studying radiation and concurrent multiagent chemotherapy in patients with locoregionally advanced squamous cell head and neck cancer. Patients and Methods Between 1989 and 2002, 222 patients were treated with 4-day continuous infusions of fluorouracil (1,000 mg/m2/d) and cisplatin (20 mg/m2/d) during weeks 1 and 4 of either once daily or twice daily radiation therapy. Primary site resection was reserved for patients with residual or recurrent primary site disease after chemoradiotherapy. Neck dissection was considered for patients with N2 or greater disease, irrespective of clinical response, and for patients with residual or recurrent neck disease. Results With a median follow-up of 73 months, the Kaplan-Meier 5-year projected overall survival rate is 65.7%, freedom from recurrence rate is 74.0%, local control without the need for surgical resection rate is 86.7%, and overall survival rate with organ preservation is 62.2%. Including patients undergoing primary site resection as salvage therapy, the overall local control rate is 92.4%. Regional control rate at 5 years is 92.4%. Among patients with N2-3 disease, regional control was significantly better if a planned neck dissection was performed. Distant control at 5 years was achieved in 85.4% of patients and was significantly worse in patients with hypopharyngeal primary sites and patients with poorly differentiated tumors. Conclusion Concurrent multiagent chemoradiotherapy can result in organ preservation and cure in the majority of appropriately selected patients with locoregionally advanced, nonmetastatic, squamous cell head and neck cancer. Distant metastatic disease was the most common cause of treatment failure. Late functional outcomes will require further investigation.

Phase III Randomized Trial of Amifostine as a Radioprotector in Head and Neck Cancer

2000 ◽  
Vol 18 (19) ◽  
pp. 3339-3345 ◽  
Author(s):  
David M. Brizel ◽  
Todd H. Wasserman ◽  
Michael Henke ◽  
Vratislav Strnad ◽  
Volkar Rudat ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Randomized Trial ◽  
Head And Neck ◽  
Neck Cancer ◽  
Phase Iii ◽  
Regional Control ◽  
Whole Saliva ◽  
Local Regional Control ◽  
Saliva Production

PURPOSE: Radiotherapy for head and neck cancer causes acute and chronic xerostomia and acute mucositis. Amifositine and its active metabolite, WR-1065, accumulate with high concentrations in the salivary glands. This randomized trial evaluated whether amifostine could ameliorate these side effects without compromising the effectiveness of radiotherapy in these patients. PATIENTS AND METHODS: Patients with previously untreated head and neck squamous cell carcinoma were eligible. Primary end points included the incidence of grade ≥ 2 acute xerostomia, grade ≥ 3 acute mucositis, and grade ≥ 2 late xerostomia and were based on the worst toxicity reported. Amifostine was administered (200 mg/m2 intravenous) daily 15 to 30 minutes before irradiation. Radiotherapy was given once daily (1.8 to 2.0 Gy) to doses of 50 to 70 Gy. Whole saliva production was quantitated preradiotherapy and regularly during follow-up. Patients evaluated their symptoms through a questionnaire during and after treatment. Local-regional control was the primary antitumor efficacy end point. RESULTS: Nausea, vomiting, hypotension, and allergic reactions were the most common side effects. Fifty-three percent of the patients receiving amifostine had at least one episode of nausea and/or vomiting, but it only occurred with 233 (5%) of 4,314 doses. Amifostine reduced grade ≥ 2 acute xerostomia from 78% to 51% (P < .0001) and chronic xerostomia grade ≥ 2 from 57% to 34% (P = .002). Median saliva production was greater with amifostine (0.26 g v 0.10 g, P = .04). Amifostine did not reduce mucositis. With and without amifostine, 2-year local-regional control, disease-free survival, and overall survival were 58% versus 63%, 53% versus 57%, and 71% versus 66%, respectively. CONCLUSION: Amifostine reduced acute and chronic xerostomia. Antitumor treatment efficacy was preserved.

Radiation Therapy With Concomitant Hydroxyurea and Fluorouracil in Stage II and III Head and Neck Cancer

1999 ◽  
Vol 17 (2) ◽  
pp. 638-638 ◽  
Author(s):  
Daniel J. Haraf ◽  
Merrill Kies ◽  
Alfred W. Rademaker ◽  
Kerstin Stenson ◽  
Bharat Mittal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Progression Free Survival ◽  
Stage Ii ◽  
Free Survival ◽  
Regional Control ◽  
Local Regional Control

PURPOSE: In 1986, a multi-institutional phase II trial was begun to study the use of chemotherapy with concomitant radiation in patients with stage II and III head and neck cancer. End points were overall survival, progression-free survival, local/regional control, and toxicity in the setting of organ preservation with concomitant treatment. METHODS: Eligible patients with stage II or III disease received chemotherapy and radiation on a 2-week cycle. Chemotherapy consisted of continuous infusion fluorouracil (5-FU) at 800 mg/m2/d for 5 consecutive days (days 1 to 5) and hydroxyurea (HU) at 1 g orally every 12 hours for 13 doses starting the evening before the start of irradiation. Radiation therapy was given as single 1.8- to 2.0-Gy fractions for 5 consecutive days (days 1 to 5) with chemotherapy. Each 5 days of treatment was followed by a 9-day break (days 6 to 14), during which no additional treatment was given. Treatment cycles were repeated until the completion of the planned radiation dose (six to eight cycles). RESULTS: Between 1989 and 1996, 60 patients were enrolled. All patients were eligible for analysis, with a median follow-up of 52 months for surviving patients and 42 months for all patients. Grade 3 to 4 mucositis occurred in 57% of patients. The 5 year-actuarial overall survival, progression-free survival, and local/regional control were 65%, 82%, and 86%, respectively. Eight patients developed local and/or regional recurrence after treatment. Surgical salvage was possible in three of these patients. Thus, the ultimate 5-year local/regional control was 91%. CONCLUSION: Concomitant radiation and chemotherapy with 5-FU and HU is an effective regimen in patients with stage II and III head and neck cancer. Progression-free survival and local/regional control appear to be superior to expected rates in patients treated with surgery and radiation. Further testing of this regimen in a phase III setting is indicated.

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