Adjuvant chemotherapy prior to postoperative concurrent chemoradiotherapy for locoregionally advanced head and neck cancer (original) (raw)
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Neoadjuvant chemotherapy in technically unresectable head and neck cancers: a retrospective audit
ecancermedicalscience
Background: The data regarding the use of neoadjuvant chemotherapy in technically unresectable head and neck cancer (HNC) is limited and real-world studies are needed to look for the efficacy and toxicities of this approach. Patients and methods: This is a retrospective study conducted in the Medical Oncology department of our hospital. All technically unresectable HNC patients who underwent neoadjuvant chemotherapy between May 2018 and May 2020 were included in this analysis. Patients received three-drug regimen docetaxel, cisplatin and 5-fluorouracil (DCF) regimen, two-drug regimens included docetaxel + cisplatin, paclitaxel + carboplatin both weekly and 3-weekly. The resectability assessment was done clinically and radiologically after completing three neoadjuvant cycles. Overall survival was calculated from the first day of chemotherapy to the date of last follow-up or date of death. Results: A total of 119 patients received neoadjuvant chemotherapy during the specified time. Response assessment showed partial response in 41.9% of patients with three-drug regimens and 37.5% of patients with other regimens. Out of 119 patients, 56 (47%) patients were offered radical intent therapy. Resectability was achieved in 32.3% of three-drug regimen patients and 26.1% of other patients. Surgery was feasible in 33 (27.7%) patients, and postoperative radiotherapy and concurrent chemotherapy were done in 30 patients (25.2%), and surgery with only postoperative radiotherapy was done in 3 patients (2.5%). Radical chemoradiotherapy was done in 23 patients (19.3%). The estimated median survival for patients who could undergo surgery was 18 months [95% confidence interval (CI), 14.9-21.0], and nonsurgical patients were 9 months (95% CI, 7.3-10.6) (p = 0.0001). Conclusion: Our study shows that neoadjuvant chemotherapy in technically unresectable HNC patients can make the disease resectable in around one-third of the patients. The patients who could undergo surgery after neoadjuvant chemotherapy had significantly improved survival as compared to those who could not.
Cancer, 2011
BACKGROUND: It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT. METHODS: The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor-prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5-fluorouracil, hydroxyurea, and a third agent. RESULTS: One hundred sixty-six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow-up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2-year rates for OS, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty-three patients (19.9%) died of treatment-related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2-year OS rate, 10.8% vs 28.4%; P ¼ .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full-dose ReRT, and radiotherapy interval. CONCLUSIONS: CReRT achieved a long-term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.11\_Nov2019/Abstract\_IJRR0058.html, 2019
Introduction: Concurrent chemoradiation is currently the standard of care in LAHNSCC. Neoadjuvant Chemotherapy (NACT) causes tumour down staging, facilitating organ preservation and has potential to prevent distant metastasis albeit at the cost of increased toxicities. However potential benefit of adding NACT before CTRT in LAHNSCC still remains unclear. Aims and Objectives: This study compared NACT followed by CTRT versus CTRT alone in LAHNSCC in terms of Locoregional response (LRR), Toxicities and Progression Free Survival (PFS). Materials and method: Patients with LAHNSCC of oral cavity, oropharynx, larynx & hypopharynx (AJCC Stage III-IVB), recruited from January 2013 to January 2015 were randomised into two arms (90 each) to receive either NACT (Paclitaxel 175mg/m 2 and Carboplatin AUC 5 q 3 weeks 3 cycles) followed by CTRT (Arm A) or CTRT alone (Arm B). EBRT dose was 66-70 Gy in conventional fractionation with three weekly Inj. Cisplatin 100 mg/m 2. Results: Median follow up period was 37 months. After NACT, 58.9% of patients achieved PR and CR 7.8%. Response 4 months after treatment showed LRR 56/65 in arm A vs. 53/71 in arm B. Median PFS was 48 months in Arm A vs. 42 months in Arm B; log rank p=0.176. Grade ≥ 3 acute toxicities included myalgia (10%), neutropenia (4.4 %), thrombocytopenia(3.3%) and anemia (3.3%) during NACT. During CTRT more haematotoxicities and mucositis in arm A whereas dermatitis and dysphagia were more in arm B. Regarding late toxicities, grade ≥ 3 neuropathy seen in Arm A. Conclusion: NACT before CTRT is feasible and may be used in LAHNSCC to downstage tumour with no significantly added toxicity.
When is chemotherapy in head and neck squamous cell carcinoma not indicated?
European Archives of Oto-Rhino-Laryngology, 2014
associated with treatment. The goals of HNSCC therapy can be categorized as either curative, employing either surgery and/or radiotherapy as a therapeutic backbone, or palliative, where symptom management and maintenance or improvement of quantity and quality of life are the primary focus. Systemic therapies (chemotherapy and targeted molecular therapeutics) have been an important addition to the therapeutic armamentarium against HNSCC. Although generally palliative when employed as a single treatment modality, systemic therapy concurrent with radiation has become an important curative option for patients with advanced locoregional disease as initial therapy or in the high-risk postoperative setting. Randomized clinical trials have demonstrated that systemic therapy concurrent with This paper was written by members of the International Head and Neck Scientific Group (www.IHNSG.com).
IRA - international journal of applied sciences, 2016
Locally advanced Head and neck cancers (LAHNSCCs) are emerging as an important public health issue in India. Our study was designed to provide NACT to LAHNSCC patients followed by comparison between chemoradiation versus only radiation in rural medical college. Material and Method: Histopathologically proven non-metastatic LAHNSCC were randomized into 2 arms. Patients in both arms initially received 3 cycles of NACT (inj Paclitaxel 175mg/m 2 and inj Carboplation AUC 6, i.v, q 21 days). Thereafter they received definitive treatment accordingly: arm A (control arm) received conventionally fractionated radiotherapy (CFRT), 70 Gy in 35 # and in arm B (study arm) received conventionally fractionated radiotherapy (CFRT), 70 Gy in 35 # with concomitant 3 weekly cisplatin 100mg/m 2. A RECIST v1.0 criterion was used for response assessment and toxicities evaluated by RTOG Acute and late Morbidity scorings.
International Journal of Radiation Oncology*Biology*Physics, 2007
To assess the feasibility and efficacy of accelerated weekly 6 fractionated 66-Gy postoperative radiation therapy (PORT) using a single fraction regimen from Monday to Thursday and a concomitant boost in the Friday afternoon sessions combined with concomitant cisplatin chemotherapy (CT) in patients with locally-advanced head and neck cancer (LAHNC). Materials/Methods: Between March 2001 and April 2006, 40 (male to female ratio: 35/5; median age: 60 years [range: 36-81]) patients with pT1-pT4 and/or pN0-pN3 LAHNC (15 oral cavity, 8 oropharynx, 8 hypopharynx, 7 larynx, and 2 unknown primary) were included in this pilot study. Indications of PORT/CT were positive surgical margins (n = 9; all R1), T4 R0 tumors (n = 5), 3 or more positive lymph nodes without extranodal infiltration (all R0; n = 2) in 16 (40%) patients; or extranodal infiltration with (all R1; n = 13) or without (n = 11) positive surgical margins in 24 (60%) patients. Median interval between surgery and RT was 46 days (range: 24-112). RT consisted of 66 Gy (2 Gy/fr) in 5.5 weeks. Median RT duration was 39 days (range: 35-62). Five-field 3D conformal or intensity-modulated RT was performed in all patients according to the GORTEC/EORTC/RTOG guidelines. Concomitant cisplatin chemotherapy was planned at 100 mg/m 2 in days 1, 22, and 43 in all but one patient where carboplatin was chosen due to impaired renal function. Prophylactic percutaneous endoscopic gastrostomy was performed in 18 (45%) patients, and 3 (8%) patients required nasogastric feeding tube. Median follow-up was 37 months (range: 5-66). Results: All but two patients received the planned total dose without unplanned interruption (66 Gy in 38, 64 Gy in 1, and 58 Gy in 1). According to the CTC/NCI v3.0 toxicity criteria, acute morbidity was acceptable: grade 3 mucositis in 10 (25%), grade 3 dysphagia in 9 (23%), grade 3 skin erythema in 5 (13%) patients. CT-related anemia was observed in 2 patients (grade 3 in 1, and grade 4 in 1), leukopenia in 4 patients (grade 3 in 2, and grade 4 in 2), and no grade 3 or 4 thrombocytopenia was observed. Grade 3 renal-function impairment was observed only in one patient. Median weight loss was 3.5 kg (range: 0-14.5). No treatmentrelated mortality was observed. Considering the late effects, grade 0, 1, or 2 xerostomia was observed in 9 (23%), 22 (55%), and 9 (23%) patients, respectively; grade 0, 1, and 2 edema in 25 (63%), 14 (35%), and 1 (3%) patients, respectively. Locoregional relapse was observed in 8 (20%) patients, and only 7 (18%) patients developed distant metastases. Median time to locoregional relapse was 6 months (range: 1-40). The 3-year overall, cause-specific, disease-free survival, and locoregional control rates were 65%, 69%, 64%, and 82%, respectively. Distant metastasis probability at 3 and 5 years was 19%. Univariate and multivariate analyses revealed that the only prognostic factor influencing the outcome was nodal status. Conclusions: We conclude that reducing the overall treatment time using accelerated PORT/CT by weekly concomitant boost (6 fractions per week) combined to concomitant cisplatin chemotherapy is easily feasible with good locoregional and distant metastases control for patients operated with curative intent for LAHNC. Acute and late RT/CT-related morbidity is acceptable.
Annals of Oncology, 2010
Background: Concomitant chemoradiotherapy (CT/RT) is the standard treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN). We evaluated the efficacy of induction docetaxel (Taxotere), cisplatin, and 5-fluorouracil (TPF) before CT/RT versus CT/RT alone. Patients and methods: Patients with stage III-IVM0 SCCHN, Eastern Cooperative Oncology Group performance status of zero to one, were randomly assigned to receive CT/RT alone (arm A: two cycles of cisplatin 20 mg/m 2 , days1-4, plus 5-fluorouracil 800 mg/m 2 /day 96 h continuous infusion, during weeks 1 and 6 of radiotherapy) or three cycles of TPF (arm B: docetaxel 75 mg/m 2 and cisplatin 80 mg/m 2 , day 1, and 5-fluorouracil 800 mg/m 2 /day 96 h continuous infusion, every 3 weeks) followed by the same CT/RT. The primary end point was the rate of radiologic complete response (CR) at 6-8 weeks after the end of CT/RT. Results: A total of 101 patients were randomly allocated to the study (51 arm A; 50 arm B). CR rates were 21.2% (arm A) versus 50% (arm B). Median progression-free survival and overall survival were, respectively, 19.7 and 33.3 months (arm A) and 30.4 and 39.6 months (arm B). Hematologic and non-hematologic toxic effects during CT/RT were similar in the two arms. Conclusion: Induction TPF followed by CT/RT was associated with higher radiologic CR in patients with locally advanced SCCHN with no negative impact on CT/RT feasibility.