This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Adelstein, D. J. Articles by Carroll, M. A. Search for Related Content PubMed PubMed Citation Articles by Adelstein, D. J. Articles by Carroll, M. A. Social Bookmarking                            What's this?

Maximizing Local Control and Organ Preservation in Stage IV Squamous Cell Head and Neck Cancer With Hyperfractionated Radiation and Concurrent Chemotherapy

From the Departments of Hematology and Medical Oncology, Radiation Oncology, Otolaryngology and Communicative Disorders, and Biostatistics, The Cleveland Clinic Foundation, Cleveland, OH.

Address reprint requests to David J. Adelstein, MD, Department of Hematology and Medical Oncology, Desk R35, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; email: adelstd@ ccf.org.

PURPOSE: Results are reported from an aggressive chemoradiotherapy protocol for advanced squamous cell head and neck cancer.

PATIENTS AND METHODS: Patients with advanced squamous cell head and neck cancer were treated with hyperfractionated radiation therapy (72 Gy at 1.2 Gy twice per day) and two courses of concurrent chemotherapy with fluorouracil (1,000 mg/m²/d) and cisplatin (20 mg/m²/d), both given as 96-hour continuous intravenous infusions during weeks 1 and 4 of radiation therapy. Primary-site resection was reserved for residual or recurrent primary-site disease after chemoradiotherapy. Neck dissection was considered for N2 or greater disease, irrespective of clinical response, and for residual or recurrent neck disease after nonoperative treatment.

RESULTS: Forty-one patients with stage IV disease were treated. Toxicity was significant, with grade 3 to 4 mucositis in 98%, dysphagia in 88%, and skin reaction in 85%. Neutropenic fever requiring hospitalization occurred in 51%. Despite feeding tube placement in 35 patients (85%), the mean weight loss during chemoradiotherapy was 13.3% of initial body weight. One patient died during treatment as a result of a pulmonary embolus. At a median follow-up period of 30 months, the 3-year Kaplan-Meier projected overall survival was 59%, disease-specific survival 69%, likelihood of local control without surgical resection 91%, and local control with surgical resection 97%. The likelihood of distant disease control at 3 years was 74%, and distant metastases were present in eight of 13 patients who died.

CONCLUSION: This chemoradiotherapy schedule produces considerable but manageable toxicity. Survival and organ preservation are excellent for this poor-prognosis patient cohort. Distant metastases are the most common cause of treatment failure.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. Brake, C. Starnes, J. Lu, D. Chen, S. Yang, R. Radinsky, and L. Borges Effects of Palifermin on Antitumor Activity of Chemotherapeutic and Biological Agents in Human Head and Neck and Colorectal Carcinoma Xenograft Models Mol. Cancer Res., August 1, 2008; 6(8): 1337 - 1346. [Abstract] [Full Text] [PDF]

				F. P. Worden, B. Kumar, J. S. Lee, G. T. Wolf, K. G. Cordell, J. M.G. Taylor, S. G. Urba, A. Eisbruch, T. N. Teknos, D. B. Chepeha, et al. Chemoselection As a Strategy for Organ Preservation in Advanced Oropharynx Cancer: Response and Survival Positively Associated With HPV16 Copy Number J. Clin. Oncol., July 1, 2008; 26(19): 3138 - 3146. [Abstract] [Full Text] [PDF]

				D. J. Adelstein Redefining the Role of Induction Chemotherapy in Head and Neck Cancer J. Clin. Oncol., July 1, 2008; 26(19): 3117 - 3119. [Full Text] [PDF]

				N. Choong and E. Vokes Expanding Role of the Medical Oncologist in the Management of Head and Neck Cancer CA Cancer J Clin, January 1, 2008; 58(1): 32 - 53. [Abstract] [Full Text] [PDF]

				J. E. Morgan, R. L. Breau, J. Y. Suen, and E. Y. Hanna Surgical Wound Complications After Intensive Chemoradiotherapy for Advanced Squamous Cell Carcinoma of the Head and Neck Arch Otolaryngol Head Neck Surg, January 1, 2007; 133(1): 10 - 14. [Abstract] [Full Text] [PDF]

				D. J. Adelstein and M. LeBlanc Does Induction Chemotherapy Have a Role in the Management of Locoregionally Advanced Squamous Cell Head and Neck Cancer? J. Clin. Oncol., June 10, 2006; 24(17): 2624 - 2628. [Abstract] [Full Text] [PDF]

				S. S. Cheng, J. E. Terrell, C. R. Bradford, D. L. Ronis, K. E. Fowler, M. E. Prince, T. N. Teknos, G. T. Wolf, and S. A. Duffy Variables Associated With Feeding Tube Placement in Head and Neck Cancer. Arch Otolaryngol Head Neck Surg, June 1, 2006; 132(6): 655 - 661. [Abstract] [Full Text] [PDF]

				D. J. Adelstein, J. P. Saxton, L. A. Rybicki, R. M. Esclamado, B. G. Wood, M. Strome, P. Lavertu, R. R. Lorenz, and M. A. Carroll Multiagent Concurrent Chemoradiotherapy for Locoregionally Advanced Squamous Cell Head and Neck Cancer: Mature Results From a Single Institution J. Clin. Oncol., March 1, 2006; 24(7): 1064 - 1071. [Abstract] [Full Text] [PDF]

				M. Merlano Alternating chemotherapy and radiotherapy in locally advanced head and neck cancer: an alternative? Oncologist, February 1, 2006; 11(2): 146 - 151. [Abstract] [Full Text] [PDF]

				D. J. Adelstein Induction Redux: Once More With Taxanes J. Clin. Oncol., December 1, 2005; 23(34): 8556 - 8558. [Full Text] [PDF]

				B. Brockstein, D. J. Haraf, A. W. Rademaker, M. S. Kies, K. M. Stenson, F. Rosen, B. B. Mittal, H. Pelzer, B. B. Fung, M.-E. Witt, et al. Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience Ann. Onc., August 1, 2004; 15(8): 1179 - 1186. [Abstract] [Full Text] [PDF]

				A.S. Garden, J. Harris, E.E. Vokes, A.A. Forastiere, J.A. Ridge, C. Jones, E.M. Horwitz, B.S. Glisson, L. Nabell, J.S. Cooper, et al. Preliminary Results of Radiation Therapy Oncology Group 97-03: A Randomized Phase II Trial of Concurrent Radiation and Chemotherapy for Advanced Squamous Cell Carcinomas of the Head and Neck J. Clin. Oncol., July 15, 2004; 22(14): 2856 - 2864. [Abstract] [Full Text] [PDF]

				T. A. Rich, R. C. Shepard, and S. T. Mosley Four Decades of Continuing Innovation With Fluorouracil: Current and Future Approaches to Fluorouracil Chemoradiation Therapy J. Clin. Oncol., June 1, 2004; 22(11): 2214 - 2232. [Abstract] [Full Text] [PDF]

				T. Crombet, M. Osorio, T. Cruz, C. Roca, R. del Castillo, R. Mon, N. Iznaga-Escobar, R. Figueredo, J. Koropatnick, E. Renginfo, et al. Use of the Humanized Anti-Epidermal Growth Factor Receptor Monoclonal Antibody h-R3 in Combination With Radiotherapy in the Treatment of Locally Advanced Head and Neck Cancer Patients J. Clin. Oncol., May 1, 2004; 22(9): 1646 - 1654. [Abstract] [Full Text] [PDF]

				E. E.W. Cohen, M. W. Lingen, and E. E. Vokes The Expanding Role of Systemic Therapy in Head and Neck Cancer J. Clin. Oncol., May 1, 2004; 22(9): 1743 - 1752. [Abstract] [Full Text] [PDF]

				M. Benasso, R. Corvo, A. Ponzanelli, G. Sanguineti, I. Ricci, E. Pallestrini, A. Santelli, V. Vitale, and R. Rosso Alternating gemcitabine and cisplatin with gemcitabine and radiation in stage IV squamous cell carcinoma of the head and neck Ann. Onc., April 1, 2004; 15(4): 646 - 652. [Abstract] [Full Text] [PDF]

				A. Argiris, B. E. Brockstein, D. J. Haraf, K. M. Stenson, B. B. Mittal, M. S. Kies, F. R. Rosen, B. Jovanovic, and E. E. Vokes Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy Clin. Cancer Res., March 15, 2004; 10(6): 1956 - 1962. [Abstract] [Full Text] [PDF]

				N. P. Nguyen, C. C. Moltz, C. Frank, P. Vos, H. J. Smith, U. Karlsson, S. Dutta, F. A. Midyett, J. Barloon, and S. Sallah Dysphagia following chemoradiation for locally advanced head and neck cancer Ann. Onc., March 1, 2004; 15(3): 383 - 388. [Abstract] [Full Text] [PDF]

				J. Aguilar-Ponce, M. Granados-Garcia, V. Villavicencio, A. Poitevin-Chacon, D. Green, A. Duenas-Gonzalez, A. Herrera-Gomez, K. Luna-Ortiz, A. Alvarado, H. Martinez-Said, et al. Phase II trial of gemcitabine concurrent with radiation for locally advanced squamous cell carcinoma of the head and neck Ann. Onc., February 1, 2004; 15(2): 301 - 306. [Abstract] [Full Text] [PDF]

				D. J. Haraf, F. R. Rosen, K. Stenson, A. Argiris, B. B. Mittal, M. E. Witt, B. E. Brockstein, M. A. List, L. Portugal, H. Pelzer, et al. Induction Chemotherapy followed by Concomitant TFHX Chemoradiotherapy with Reduced Dose Radiation in Advanced Head and Neck Cancer Clin. Cancer Res., December 1, 2003; 9(16): 5936 - 5943. [Abstract] [Full Text] [PDF]

				D. L. Schwartz, J. Rajendran, B. Yueh, M. Coltrera, Y. Anzai, K. Krohn, and J. Eary Staging of Head and Neck Squamous Cell Cancer With Extended-Field FDG-PET Arch Otolaryngol Head Neck Surg, November 1, 2003; 129(11): 1173 - 1178. [Abstract] [Full Text] [PDF]

				A. Argiris, D. J. Haraf, M. S. Kies, and E. E. Vokes Intensive Concurrent Chemoradiotherapy for Head and Neck Cancer with 5-Fluorouracil- and Hydroxyurea-Based Regimens: Reversing a Pattern of Failure Oncologist, August 1, 2003; 8(4): 350 - 360. [Abstract] [Full Text] [PDF]

				F. R. Rosen, D. J. Haraf, M. S. Kies, K. Stenson, L. Portugal, M. A. List, B. E. Brockstein, B. B. Mittal, A. W. Rademaker, M. E. Witt, et al. Multicenter Randomized Phase II Study of Paclitaxel (1-Hour Infusion), Fluorouracil, Hydroxyurea, and Concomitant Twice Daily Radiation with or without Erythropoietin for Advanced Head and Neck Cancer Clin. Cancer Res., May 1, 2003; 9(5): 1689 - 1697. [Abstract] [Full Text] [PDF]

				E. E. Vokes, K. Stenson, F. R. Rosen, M. S. Kies, A. W. Rademaker, M. E. Witt, B. E. Brockstein, M. A. List, B. B. Fung, L. Portugal, et al. Weekly Carboplatin and Paclitaxel Followed by Concomitant Paclitaxel, Fluorouracil, and Hydroxyurea Chemoradiotherapy: Curative and Organ-Preserving Therapy for Advanced Head and Neck Cancer J. Clin. Oncol., January 15, 2003; 21(2): 320 - 326. [Abstract] [Full Text] [PDF]

				M. Machtay, D. I. Rosenthal, D. Hershock, H. Jones, S. Williamson, M. J. Greenberg, G. S. Weinstein, V. M. Aviles, A. A. Chalian, and R. S. Weber Organ Preservation Therapy Using Induction Plus Concurrent Chemoradiation for Advanced Resectable Oropharyngeal Carcinoma: A University of Pennsylvania Phase II Trial J. Clin. Oncol., October 1, 2002; 20(19): 3964 - 3971. [Abstract] [Full Text] [PDF]