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Category: Volume 08 Issue 02 February 2020
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Title: 3 Arm comparisons to evaluate the role of concurrent chemoradiation in locally advanced squamous cell carcinoma of head & neck region

Authors: Tabassum Samani, Alvin Anto, A K Arya

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.82

Abstract

   

Background: In locally advanced squamous cell carcinoma of head and neck regionthe most widely used drug in concurrent chemoradiation is cisplatin but the optimal regimen of cisplatin is still not defined. The aim of this study was to determine the efficacy of CCRT with weekly cisplatin vs 3 weekly cisplatin and 5 fluorouracil and to compare it with conventional radiotherapy only treatment. We also evaluated the toxicity of the 3 arms.

Material and Method: Outcome data of 60 patients of histologically proven squamous cell carcinoma of head and neck treated between 2007-2010 was analysed. 20 patients had received only conventional RT; 20 patients had received conventional RT along with weekly cisplatin and 20 patients had received conventional RT along with cisplatin & 5-FU on D1-D4 &D22-25 of RT.

Results: At 5 years overall survival was 25% in the RT only arm, 50% in the weekly cisplatin arm and 35% in the 3 weekly cisplatin and 5-FU arm. The DFS was 20%, 40% &25% respectively in the 3 arms.

Conclusion: Patients treated with weekly cisplatin CCRT had a higher 5 year OS and DFS as compared to those treated with 3 weekly cisplatin & 5FU CCRT or RT alone.

References

  1. Halperin, E.C., Perez C.A. et al. Principles and Practices of Radiation Oncoloy. 2013; (6): 718.
  2. Kulkarni, M.R. Head and Neck Cancer burden in Indian. Internatioanl Journal of Head and Neck Surgery 20134(1): 29-35.
  3. Forastiere A, Koch W, Ttotti A, Sidransky D: Medical progress – Head and Neck cancer. N Eng J Med. 2001, 345: 1890 – 1900, 10: 1056/NEJM ra 001375
  4. Chin D, Boyle GM, Porceddu S, Theile DR, Parsons PG, ComanWB : Head and Neck cancer – Past Present and Future. Expert Rev Anticancer Ther. 2006, :1111-1118
  5. Pignon JP, Bourhis J, Domenge C, Designe L: Chemotherapy added to locoregional treatment for head and neck squamous – cell carcinoma: three meta – analyses of updated individual data. Lancet. 2000, 355: 949-955
  6. Pignon JP, le Maitre A, Bourhis J, MACH-NC Collaborative group: Meta – analyses of Chemotherapy in Head and Neck Cancer ( MACH – NC). Int J Radiat Oncol Phys. 2007, 69 (2 suppl): S112 -114
  7. Pignon JP, Baujat B, Bourhis J: Individual patient data meta – analyses in head and neck carcinoma: What have we learnt? Cancer Radiother. 2005, 9: 31-36.
  8. Salama J.K., Seiwert T.Y., Vokes E.E. Chemoradiotherapy for locally advanced head and neck cancer. J. Clin Oncol. 2007; 25: 4118-26.
  9. Pignon J.P., Le Maitre A., Maillard E., Bourhis J. MACH-NC collaborative group. Meta analysis of chemotherapy in head and neck cancer (MACH-NC) an update on 93 randomised trials and 17,346 patietns. Radiother. Oncol. 2009; 92(1): 4-14.
  10. Adelstein Dj, Li Y, Adams G.L., Wagner H., Jr. Kush J.A. Ensley J.F. et al., An intergroup phase III comparison of standard radiation therapy and two scheules of concurrent chemoradiontherapy in patients with unrsectable squamous cell had nad neck cancer. J. Clin Oncol. 2003; 231: 92-8.
  11. Bernier J, Domenge C, Ozsahin M et al.Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350(19):1945–1952.
  12. Cooper J S, Pajak T F, Forastiere A A et al.Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–1944.
  13. Fountzilas G, Skarlos D, Kosmidis P et al. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic Co-operative Oncology Group study. Acta Oncol. 1994;33(07):825–830.
  14. Bloom E.J., Green M.D. et al. Concomitant use of cisplatin and radiotherapy in the treatment of advanced head and neck cacner, Oncology, 1985; 4: 137.
  15. Tribius S, Kronemann S, Kilic Y., Schroder U. et al., Radiochemotherapy including cisplatin alone versus cisplatin + 5FU for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Strahlenther Oncol. 2009; 185(10): 675-81.
  16. Uygun K., Bilci A., Karogol H. et al. The comparison of weekly and thrice weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated in operable non-metastatic squamous cell CA of H&N Cancer, Chothe. Pharmacol. 2009: 64(3) 601-5.
  17. Wendt T.G., Grabenbauer GG, Rodel CM, Thiel HJ, Aydinh, Rohloff R, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer. A randomized multicenter study. J. Clin. Oncol 1998; 16: 1318-24.
  18. Adelstein D.J., Lavertu P., Saxton J.P. Secec M, Wood B.G., Wanamaker J.R., Eliachar I, Strome M, Lato M.A. Mature results of a phase III randomised trial comparing  concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the Head & Neck Cancer, 2000; Feb. 2015; 88(4): 876-83.
  19. Gupta T., Agarwal J.P., Ghosh Laskar, S., Parikh, P.M. D’Cruz, A.K., Dinshaw, K.A. Radical radiotherapy with concurrent weekly cisplatin in locoregionally advanced squamous cell carcinoma of the head and neck : a single institution experience, Head Neck Oncol. 2009; 1:
  20. Forastiere AA,Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol.2013 Mar 1;31(7): 845-52. doi: 10.1200/JCO.2012.43.6097. Epub 2012 Nov 26.

Corresponding Author

Dr Tabassum Samani

Assistant Professor, Department of Radiotherapy, S.N. Medical College & hospital, Agra, Uttar Pradesh, INDIA