Combined modality [chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer

ABSTRACT

Generally radiotherapy alone or combined with surgery for locally advanced head and neck epidermoid carcinoma yields poor results. This study was designed to assess the therapeutic efficiency of combined modality treatment [neoadjuvant chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer and to evaluate its impact on the progression free and overall survival. Three cycles of cisplatin [100 mg/m[2]] day I and 5-fluorouracil [1 gm/m[2]] days 1-3 repeated every 21 days were given for 30 untreated patients followed by radiation therapy. This arm [group I] was compared with radiation therapy alone In another 30 patients [group II]. These patients had stages III and IV disease with performance of 70=70% and with a minimum followed up of 18 months. In group I neoadjuvant chemotherapy induced complete response [CR] in seven patients [23.3%] and partial response [PR] in 19 patients [63.3%]. After the addition of radiation therapy, CR increased to 56.7%. In the radiotherapy alone group. CR and PR were 40% and 43.3% respectively The difference between both arms as regards the overall response was not statistically significant [p=0.704]. The chemotherapy schedule was tolerable but it increased the acute radiation reactions to the extent that eight patients could not tolerate the boost radiation dose. The progression free survival [PFS] of responders in the combined treatment arm was 52% compared with 44% in radiation alone ann. The median time to progression was 8.2 months versus 7.3 months in both arms respectively. The overall survival [OS] was higher in the combined treatment arm but not statistically significant [p>0.05]. Neoadjuvant chemotherapy could improve the response rate and OS with acceptable local and systemic toxicity. Accrual of large number of patients and longer follow up period is needed to emphasis the advantageous effect of neoadjuvant chemotherapy