Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers

Abstract

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation.However, survival of this patient population has not improved during the past 20 years. Many differentmultimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organpreservation. The present study was intended to establish the efficacy of concomitant chemoradiation with asingle agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility ofconcomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacuteside effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conductedwherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx,hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weeklycarboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy)to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease.Neck dissection was recommended for all patients with neck disease showing less than a complete responseafter chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highestincidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumoursconstituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% ofthe patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had gradeII mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions,65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion oftreatment 65% of patients had complete response at the primary and regional sites, and 35% of patients hada partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at theprimary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease.Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head andneck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary siteconservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primarymanagement of head and neck cancers.