Journal of Clinical Oncology, Vol 21, Issue 1
(January), 2003: 92-98
© 2003 American Society for Clinical Oncology
An Intergroup Phase III Comparison of Standard Radiation Therapy and Two Schedules of Concurrent Chemoradiotherapy in Patients With Unresectable Squamous Cell Head and Neck Cancer
David J. Adelstein,
Yi Li,
George L. Adams,
Henry Wagner, Jr,
Julie A. Kish,
John F. Ensley,
David E. Schuller,
Arlene A. Forastiere
From the Cleveland Clinic Foundation, Cleveland; Arthur G. James Cancer Hospital, Columbus, OH; Dana-Farber Cancer Institute, Boston, MA; Fairview University Medical Center (University of Minnesota), Minneapolis, MN; H. Lee Moffitt Cancer Center, Tampa, FL; Henry Ford Hospital, and Karmanos Cancer Institute, Wayne State University, Detroit, MI; and Johns Hopkins University, Baltimore, MD.
Address reprint requests to David J. Adelstein, MD, The Cleveland Clinic Foundation, Department of Hematology and Medical Oncology, Desk R35, 9500 Euclid Ave, Cleveland, OH 44195; email: adelstd{at}ccf.org.
Purpose: The Head and Neck Intergroup conducted a phase III randomized trial to test the benefit of adding chemotherapy to radiation in patients with unresectable squamous cell head and neck cancer.
Patients and Methods: Eligible patients were randomly assigned between arm A (the control), single daily fractionated radiation (70 Gy at 2 Gy/d); arm B, identical radiation therapy with concurrent bolus cisplatin, given on days 1, 22, and 43; and arm C, a split course of single daily fractionated radiation and three cycles of concurrent infusional fluorouracil and bolus cisplatin chemotherapy, 30 Gy given with the first cycle and 30 to 40 Gy given with the third cycle. Surgical resection was encouraged if possible after the second chemotherapy cycle on arm C and, if necessary, as salvage therapy on all three treatment arms. Survival data were compared between each experimental arm and the control arm using a one-sided log-rank test.
Results: Between 1992 and 1999, 295 patients were entered on this trial. This did not meet the accrual goal of 362 patients and resulted in premature study closure. Grade 3 or worse toxicity occurred in 52% of patients enrolled in arm A, compared with 89% enrolled in arm B (P < .0001) and 77% enrolled in arm C (P < .001). With a median follow-up of 41 months, the 3-year projected overall survival for patients enrolled in arm A is 23%, compared with 37% for arm B (P = .014) and 27% for arm C (P = not significant).
Conclusion: The addition of concurrent high-dose, single-agent cisplatin to conventional single daily fractionated radiation significantly improves survival, although it also increases toxicity. The loss of efficacy resulting from split-course radiation was not offset by either multiagent chemotherapy or the possibility of midcourse surgery.
This study was conducted by the Eastern Cooperative Oncology Group (Robert L. Comis, MD, Chair) and supported in part by Public Health Service grants nos. CA23318, CA66636, CA21115, CA04919, CA73590, CA58416, VA14028, CA04920, and CA16116 from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.
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