scholarly journals Effect of Concurrent Chemoradiation for Advanced Head and Neck Malignancy in a Tertiary Care Centre, Kerala

2021 ◽  
Vol 10 (28) ◽  
pp. 2094-2098
Author(s):  
Ravisankar Thommanparambil Raveendran ◽  
Shehna Abdul Khader ◽  
Ajith Kumar Vilasini Raghavan ◽  
Jayaraman Madambath Balan ◽  
Krishnannair Lalithamma Jayakumar
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Response Rate ◽  
Complete Response Rate ◽  
Locally Advanced ◽  
Complete Response ◽  
Concurrent Chemotherapy ◽  
Advanced Head ◽  
One Year

BACKGROUND Concurrent chemotherapy is a well-established treatment modality for locally advanced head and neck cancer. The concept of concurrent chemotherapy and radiation was introduced in an attempt to improve the local control and possibly influence the survival because of the high rate of local and distant failures observed with the combination of surgery and postoperative radiation. The relevance of this study was to assess the efficacy of our treatment and patience compliance and also study the effect in patients treated with cisplatin based concurrent chemo radiotherapy in advanced head and neck cancer. METHODS The prospective study was conducted in the Department of Radiotherapy, Government Medical college, Thrissur, Kerala comprising the newly diagnosed patients with locally advanced head & neck cancers over one year. Conventional radiotherapy with a dose of 66 Gy in 33 fractions over 6.5 weeks was given concurrently with Inj cisplatin 100 mg / 2 IV every 3 weeks and periodically followed up for one year. RESULTS This study revealed that complete response rate was higher in 61 – 70 year age group compared to lower age groups. Complete response cases were slightly higher in T1 disease compared to higher stages. Regarding nodal status, complete response and DFS were more in N0 tumours and worst in N3 tumours. It was found that complete response rates were slightly higher in stage III than stage IV. Comparing the grade of the tumour, complete response cases were slightly higher in WD and MD compared to PD. Complete response rate and disease free survival (DFS) were slightly higher in cases who had more than two chemotherapy cycles compared to one cycle. CONCLUSIONS Concurrent chemo radiation was not well tolerated in our study group. Only 23.5 % patients were able to complete the planned treatment. The positive side was that complete response was found in about 79.4 % of study patients & DFS at one year was 80 %. KEY WORDS Concurrent Chemo Radiation, Head and Neck Cancer, Cisplatin

Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer.

1994 ◽  
Vol 12 (12) ◽  
pp. 2648-2653 ◽  
Author(s):  
G P Browman ◽  
C Cripps ◽  
D I Hodson ◽  
L Eapen ◽  
J Sathya ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Response Rate ◽  
Complete Response Rate ◽  
Performance Status ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
Complete Response ◽  
Survival Duration

PURPOSE To determine whether the addition of infusional fluorouracil (I-FU) to standard radiotherapy improves survival at acceptable toxicity in patients with locally advanced squamous cell head and neck cancer (SCHNC). PATIENTS AND METHODS Consenting patients with an Eastern Cooperative Oncology Group (ECOG) performance status < or = 2; with stage III or IV SCHNC of the oral cavity, oropharynx, hypopharynx, or larynx; and who were recommended for radiotherapy with curative intent received 66 Gy of radiation therapy delivered in 2-Gy fractions once daily 5 days per week for 6 1/2 weeks. Those in the experimental arm received I-FU 1.2 g/m2/d, as a 72-hour infusion in the first and third weeks of radiation. Saline infusions were used in the placebo arm. RESULTS One hundred seventy-five patients were randomized (88 to I-FU and 87 to placebo), and the treatment arms were well balanced. The complete response rate was 68% for I-FU and 56% for placebo (P = .04). The overall median survival duration was 33 months for I-FU and 25 months for placebo (P = .08). Progression-free survival also favored I-FU (P = .06). Toxicity was greater in I-FU patients, but did not interfere with the scheduled delivery or completion of radiation. CONCLUSION The addition of I-FU to standard radiation in SCHNC improved the complete response rate and was associated with beneficial trends in progression-free and overall survival compared with radiation alone. I-FU patients also experienced greater morbidity, but this did not compromise delivery of radiotherapy.

Cisplatin and fluorouracil chemotherapy does not yield long-term benefit in locally advanced head and neck cancer: results from a single institution.

1991 ◽  
Vol 9 (8) ◽  
pp. 1376-1384 ◽  
Author(s):  
E E Vokes ◽  
R Mick ◽  
E P Lester ◽  
W R Panje ◽  
R R Weichselbaum
Keyword(s):  
Head And Neck Cancer ◽  
Adjuvant Chemotherapy ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Survival Data ◽  
Locally Advanced ◽  
Local Therapy ◽  
Complete Response ◽  
Advanced Head

Fifty-one patients with locally advanced head and neck cancer were treated with three cycles of cisplatin at 100 mg/m2 followed by 5-day continuous infusion fluorouracil (5-FU) at 1,000 mg/m2/d as induction chemotherapy. Subsequent local therapy consisted of surgery for patients with resectable disease and/or radiotherapy. Three cycles of adjuvant chemotherapy were administered to patients with partial response (PR) or complete response (CR) to induction chemotherapy. Twenty-two patients (43%) had a clinical CR that was pathologically confirmed in 12 patients (24%), and 24 patients (47%) had a PR for an overall response rate of 90%. Local therapy included surgery in 24 patients (47%) and radiotherapy alone in 22 patients (43%). Adjuvant chemotherapy was administered to 32 patients (63%) frequently at great dose reduction. At a median follow-up of 90 months, the median survival is 22 months (95% confidence interval, 15 to 36 months), and the 5-year survival is 25%, with only five patients known to be alive and disease-free at this time. The median time to progression is 14 months, with 29 patients (57%) having documented progression of their head and neck cancer and eight (16%) having progression of a second neoplasm. Seven patients died of intervening medical events. This high incidence of second malignancies supports the continued investigation of chemoprevention for patients in CR. Despite the known high response rates achieved with cisplatin and 5-FU induction chemotherapy, the overall poor survival data reported here should lead to a thorough reexamination of the frequent administration of this regimen in the community.

Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer

2015 ◽  
Vol 191 (6) ◽  
pp. 501-510 ◽  
Author(s):  
Silke Tribius ◽  
Marieclaire Raguse ◽  
Christian Voigt ◽  
Adrian Münscher ◽  
Alexander Gröbe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Advanced Head ◽  
Intensity Modulated ◽  
One Year

Phase I trial of chemotherapy combination with docetaxel, cisplatin and S-1 (TPS) in patients with locally advanced or recurrent/ metastatic head and neck cancer (HNC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6064-6064
Author(s):  
M. Tahara ◽  
K. Araki ◽  
N. Kiyota ◽  
S. Takeuchi ◽  
N. Fuse ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Response Rate ◽  
Locally Advanced ◽  
Complete Response ◽  
Maximum Tolerated Dose ◽  
Eligibility Criteria ◽  
Adequate Organ Function ◽  
Grade 3

6064 Background: An oral fluoropyrimidine, S-1, has shown high efficacy against head and neck cancer (HNC) with a response rate of 34% and preclinical data has demonstrated a possible synergy with platinums and taxanes. The aim of this study was to determine the maximum tolerated dose (MTD) of a combination therapy with TPS in patients (pts) with locally advanced or recurrent/ metastatic HNC. Methods: The eligibility criteria were: histologically proven squamous cell carcinoma of the head and neck with recurrent/metastatic and locally advanced lesions, PS 0–1, age =75 years, adequate organ function, and no prior chemotherapy. Chemotherapy consisted of 1-hour infusion of docetaxel at escalating doses of 50 and 60 mg/m2, 2-hour infusions of cisplatin at 70 mg/m2/day on day 1 and S-1 twice daily on days 1–14 at escalating doses of 40, 60, and 80 mg/m2/day. The treatment was repeated every 4-weeks. Results: Twenty two pts were enrolled. These were 17 males and 5 females with a median age of 50 years (22–74). There were 11 locally advanced and 11 metastatic cases. Median of 3 cycles were administrated (range 1–6; total 77 cycles). Anorexia, nausea, neutropenia and anemia were the most frequently observed adverse events. Grade 3 or 4 hematological toxicities were neutropenia (59%), febrile neutropenia (0%), anemia (14%) and thrombocytopenia (0%). Although a total of 12 pts were treated with TPS at doses of 60/70/80 mg/m2/day, one-dose limiting toxicity (grade3 infection) was observed at these doses, but MTD was not reached. As the approved dose of S-1 is 80 mg/m2, further dose escalation was not conducted. In a total of 22 pts treated with the TPS, 3 (1 locally advanced, 2 metastatic cases) achieved complete response and 11 (7 locally advanced, 4 metastatic cases) achieved partial response according to RECIST with an overall response rate of 64%. Conclusions: The TPS combination was well tolerated in pts with locally advanced or recurrent/ metastatic HNC. Although MTD was not reached and the data were preliminary, the antitumor activity was very promising, and this warrants further investigation. No significant financial relationships to disclose.

Comparison between hypo-fractionated dose-escalated volumetric modulated arc therapy and conventional concurrent chemo-radiation in locally advanced head and neck cancer: a pilot study

2019 ◽  
Vol 19 (2) ◽  
pp. 132-138
Author(s):  
Ehab Saad ◽  
Riham Hani Radwan ◽  
Eman Abdel Hadi
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Comparable Efficacy ◽  
Advanced Head ◽  
Arc Therapy ◽  
To Receive

AbstractObjective:In the treatment of locally advanced head and neck cancer (LA-HNC), both dose escalation and hypo-fractionation can improve tumour control rates with uncertain role of addition of concurrent chemotherapy. We aimed at developing a new radiotherapy protocol for patients not eligible to receive the standard concurrent chemo-radiation therapy (CCRT) with little toxicity profile.Methods:A total of 63 LA-HNC patients were randomised to receive either: 70 Gy in 35 fx in 7 weeks concurrently with cisplatin 100 mg/m2 every 3 weeks for 3 doses (Arm A) or 74 Gy in 33 fx in 6·5 weeks (Arm B). Volumetric modulated arc therapy plans were created for both treatment arms. We compared the local control (LC), progression-free survival (PFS), overall survival (OS) and acute and late toxicity between the two arms.Results:A total of 33 patients were in Arm A versus 30 patients in Arm B with median follow-up 24·2 months. No significant differences in LC, PFS and OS between the two arms. Complete remission occurred in 54·5 and 63·3% of patients in Arms A and B, respectively. All toxicities were significantly less in Arm B than Arm A.Conclusion:Slightly dose-escalated hypo-fractionated regimen is safe and feasible and has comparable efficacy and less acute and late side effects than conventional dose CCRT with avoidance of chemotherapy-related toxicities in LA-HNC patients.

scholarly journals Determining Malnutrition Assessment Criteria to Predict One-Year Mortality for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 836 ◽  
Author(s):  
Hang Huong Ling ◽  
Kun-Yun Yeh ◽  
Shu-Hang Ng ◽  
Cheng-Hsu Wang ◽  
Chien-Hong Lai ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Mortality Rate ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Prognostic Nutritional Index ◽  
Assessment Methods ◽  
Advanced Head ◽  
One Year ◽  
The Impact

Study on the impact of pretreatment malnutrition on treatment outcomes in locally advanced head and neck cancer (LAHNC) patients is still lacking. We prospectively collected various malnutrition assessment methods including nutrition indexes, inflammatory biomarkers, and lean body mass index (LBMI) data before treatments. The one year mortality rate was assessed, and the factors associated with this outcome were investigated. Furthermore, the association between malnutrition assessment methods was examined. A total of 113 patients were enrolled. By prognostic stratification based on the prognostic nutritional index (PNI) and platelet-to-lymphocyte ratio (PLR) combination, the low PNI/high PLR group had highest and the high PNI/low PLR group had the lowest mortality rate. Furthermore, the PNI was positively correlated with the LBMI, and the PLR was inversely correlated with the LBMI. PNI and PLR were found to be independent prognostic factors of one year mortality and also associated with the loss of muscle.

Hyperfractionated Irradiation with or without Concurrent Chemotherapy for Locally Advanced Head and Neck Cancer

1998 ◽  
Vol 338 (25) ◽  
pp. 1798-1804 ◽  
Author(s):  
David M. Brizel ◽  
Mary E. Albers ◽  
Samuel R. Fisher ◽  
Richard L. Scher ◽  
William J. Richtsmeier ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Advanced Head

“CLINICALASSESSMENT OF TREATMENT RELATED TOXICITY AND RESPONSE BY CONCOMITANT CHEMORADIATION THERAPY IN LOCALLY ADVANCED HEAD AND NECK CARCINOMA”

2021 ◽  
pp. 79-81
Author(s):  
Swapan Kumar Mallick ◽  
Rinki Saha
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Treatment Options ◽  
Locally Advanced ◽  
Stage Iv ◽  
Head And Neck Carcinoma ◽  
Complete Response ◽  
Advanced Head

Introduction: Head and neck cancer is the commonest malignancy in India. Most of the cases present are at a locally advanced stage. Concurrent chemo radiotherapy is one of the treatment options in locally advanced Head & Neck Cancer patients. Materials & Methods: Locally advanced head and neck cancer patients attending the Out Patient Department of Radiotherapy from May 2018 to February 2020. Patients were treated with concurrent chemoradiation and followed for a minimum period of 9 months. Results: On analysing the pattern of response, it was noted that, in the chemoradiation complete response was seen in 20 patients (66.66%), partial response in 6 patients (20%), stable disease in 2 patients (6.66%) and progressive disease in 1 patient (3.33%). In our study, complete Response in case of Stage III was seen in 18 patients and other form of response was seen in 3 patients . In case of Stage IV A and IV B , Complete Response in 2 patients and other form of response was in 6 patients respectively. Haematological toxicities like neutropenia (3.3%), thrombocytopenia (0%) and anaemia (3.3%) were seen. Acute toxicities like oral mucositis and skin reaction were observed 10% in both the cases. Conclusions: The present study, Concomitant chemoradiotherapy improved overall survival and locoregional control. Preservation of function is a major endpoint of interest.

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