- Johns Hopkins Kimmel Cancer Center
Toxicities were significantly higher among patients receiving chemoradiation than for those who received radiation alone.
Adding chemotherapy to radiation for advanced head and neck cancer (HNC) treatment does not improve overall survival, according to preliminary results from a multicenter study presented at the 38th Annual Meeting of ASCO here. Although further patient follow-up is needed and additional studies are warranted, we continue to recommend that patients receive the current standard of care surgery followed by radiation alone,” said Arlene Forastiere, MD, professor of oncology and otolaryngology at the Johns Hopkins Kimmel Cancer Center in Baltimore. Early studies suggested that combining certain chemotherapy drugs and radiation may have a synergistic effect in [patients with advanced HNC],” she said. Our current study shows that adding cisplatin to standard radiation treatment does not significantly reduce recurrence.”
Forastiere and her colleagues evaluated 459 patients who had high-risk squamous cell carcinomas of the head and neck. After surgery to remove all detectable disease, all patients received 60 to 66 Gy in 30 to 33 fractions over 6.0 to 6.6 weeks. A group of 228 patients were randomly assigned to also receive 100 mg/m2 of IV cisplatin (Platinol, Bristol-Myers Squibb) on days 1, 22 and 43.
With a median follow-up of 26.6 months, there was no significant difference in local cancer recurrence between the two groups. The local-regional control rate was 73.8% for patients who received only radiation and 79.2% for those who received chemoradiation. The two-year overall survival rate was 56.6% with radiation and 62.9% with chemoradiation. The difference was not significant, Forastiere said. There was a significant difference in disease-free survival — 42.5% with radiation and 52.2% with chemoradiation — but the improvement came at the cost of significantly increased acute and total toxicity, she said.
About 58% of patients in the chemoradiation group were able to take all three doses of chemotherapy. The fact that many of these patients receiving combination therapy could not handle all of the chemotherapy suggests that we should look in another direction. Adding targeted drugs and those with fewer adverse events may be a better alternative,” Forastiere said. Grade-3 or higher toxicity occurred in 74.9% of patients in the chemoradiation arm, compared with 32.8% of those in the radiation-only arm. Most of the events related to cisplatin were from hematologic, mucous membrane or gastrointestinal toxicities. These were consistent with typical adverse events from chemotherapy, according to the study. Three patients receiving chemoradiation died during the study. There were no study deaths in the radiation-only group.
For more information:
*Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiochemotherapy in high-risk SCCA of the head and neck: initial report of RTOF 9501/Intergroup phase III trial. Abstract #903. Presented at the 38th Annual Meeting of ASCO. May 18-21, 2002. Orlando, Fla.