• 9/7/2007
  • web-based article
  • PM Specenier et al.
  • Annals of Oncology, doi:10.1093/annonc/mdm346

Background:
Radiotherapy (RT) with concurrent chemotherapy is the current standard of care for patients with unresectable locally advanced squamous cell carcinoma of the head and neck (SCCHN). Gemcitabine (GEM) is a potent radiosensitizer and in addition has activity as an anticancer agent in SCCHN.

Patients and methods:
Twenty-six patients with locally far advanced SCCHN were enrolled in a chemoradiation feasibility study between November 1998 and September 2003. Use was made of conventionally fractionated RT and GEM 100 mg/m2, which was given within 2 h prior to radiotherapy on a weekly basis starting on day 1 of RT. Response was assessed according to WHO criteria, toxicity according to NCI-CTC version 2.

Results:
The patients received a median of 7 (2–8) weekly cycles of gemcitabine and a median cumulative RT dose of 70 Gy (66–84.75). Hematologic toxicity was mild, but non-hematologic toxicity was severe: grade 3–4 stomatitis occurred in 85% of patients, dermatitis in 69%, pharyngitis/esophagitis in 81% and 80% of the patients needed a feeding tube during treatment. All 22 evaluable patients responded (50% complete, 50% partial). Median follow up of the surviving patients is 46 months. Median disease-free and overall survival is 13 months and 19 months, respectively; 27% of the patients are alive without evidence of recurrence beyond 3 years.

Conclusions:
Conventionally fractionated RT in combination with GEM 100 mg/m2 weekly is feasible and highly active in the treatment of locally advanced SCCHN. In particular, long-term local control rate is promising. Acute mucosal toxicities are significant but manageable. Long-term toxicity interferes with normal food intake.

Authors:
PM Specenier1, D Van den Weyngaert2, C Van Laer3, J Weyler4, J Van den Brande1, MT Huizing1, J Dyck1, D Schrijvers1,5 and JB Vermorken1

Authors’ affiliations:
1 Department of Medical Oncology, University Hospital Antwerp, Edegem
2 Department of Radiotherapy, Campus Middelheim, ZNA Hospital Network, Antwerp
3 Department of Otolaryngology, University Hospital Antwerp, Edegem
4 Epidemiology and Community Medicine, Center for Cancer Prevention, University of Antwerp, Edegem
5 Department of Medical Oncology Campus Middelheim, ZNA Hospital Network, Antwerp, Belgium