Concurrent chemoradiotherapy for patients with locally advanced head & neck squamous cell carcinoma (LA-HNSCC)

• Published in: OTOLOGIA FUKUOKA Vol. 46; no. 4Supplement2; pp. S68 - S70
• Main Author: FUJII, Hirofumi
• Format: Journal Article
• Language: Japanese
• Published: JIBI TO RINSHO KAI 20.09.2000
• Subjects: シスプラチン; フルオロウラシル; 化学療法併用放射線療法; 局所進行頭頸部癌
• ISSN: 0447-7227; 2185-1034
• DOI: 10.11334/jibi1954.46.4Supplement2_S68

Background: Concurrent chemoradiation improves survival over radiation alone in unresectable HNSCC. We evaluated the efficacy and toxicity of concurrent FP-RT in patients with unresectable LA-HNSCC. Patients & Method: FP-RT: 5-FU 200mg/m2 (Day 1-6, 8-13, 35 -40, 42-47: CI), CDDP 40mg/m2 (Day 1, 8, 35, 42), RT 2 Gy/day (Day 1-5, 8-12, 15-19, 35 -39, 42-46, 49-53). After radiation therapy to 60 Gy, patients were evaluated for response and those with CR at the primary site continued radiotherapy up to 66-72 Gy. Patients who achieved CR in primary site and had residual but resectable neck lymph nodes underwent neck dissection after completion of radiotherapy. Results: Patient characteristics were: F/M: 3/24, Age (median, range: 57, 41-67), Stage III/IV: 1/26. Hematological toxicities include: 7% grade 4 leukopenia and neutropenia, 44% grade 3 anemia and 4% grade 4 thrombocytopenia. Grade 3 mucositis was seen in 70%. Two patients died with methicillin resistance Staphylococcus aureus pneumonia. After FP-RT, overall response rate was 85% including 22% CR. CR rate of primary site and that of lymph nodes were 60% and 30%, respectively. 3/4 patients who underwent radical neck resection had residual tumor. Laryngeal preservation rate at 1 year was 44% in patients who were followed more than 1 year. Finally overall CR rate was 33%. Median survival time was 11 months. Conclusion: Although supportive cares were very difficult, FP-RT was the feasible and tolerable treatment. After FP-RT, there were no major complication for neck dissection, but it was very difficult to perform the modified neck dissection. FP-RT was one of the effective regimen for laryngeal preservation in the treatment of LA-HNSCC.