Treatment of patients with unresectable squamous head and neck cancer with induction chemotherapy followed by hyperfractionated radiotherapy.

OBJECTIVE

The contribution of induction chemotherapy (CT) followed by hyperfractionated radiotherapy (hfRT) in unresectable squamous head and neck cancer has been evaluated in a single institution as an assistencial protocol.

METHODS

From March 1994 to June 2000 all consecutive patients with unresectable disease were treated with four courses of platin plus fluorouracil based CT followed by hfRT. Tumor resectability and response was assessed by a multidisciplinary committee.

RESULTS

Ninety-nine patients (pts) were treated. All of them had stage IV-M0 disease: 67 T4, 88 N2-N3. Tumor location: 62 oropharynx, 22 hypopharynx, eight oral cavity and seven larynx. Tumor response at the end of treatment: 61 patients complete response, 17 partial response, two stable disease, 10 progressive disease and nine unevaluated. With a median follow-up of 70 months the 5-year loco-regional control and overall survival was 30.3% (95% CI: 21.9-38.6) and 21.6% (95% CI: 13.4-29.8), respectively. Loco-regional control and overall survival is significantly influenced by prior response to induction CT. Main grade 3-4 toxicity related to CT was stomatitis, but there were five patients with an ischemic event. Grade 3-4 acute toxicity related to hfRT: 47 stomatitis, 20 epithelitis. Chronic toxicity related to hfRT: six emergency tracheotomies due to laryngeal edema, five pneumonia and one mucous/soft-tissue necrosis. There were eight toxic related deaths.

CONCLUSIONS

Induction CT followed by hfRT might increase the overall survival rate in unresectable disease. HfRT resulted in a high rate of acute toxicity and its use would not be warranted in those patients with no response to induction CT who had a low probability of long-term control.