Adjuvant cisplatin with concurrent radiation therapy for resectable locally advanced carcinoma of head and neck

ABSTRACT

This randomized prospective study was performed to evaluate the efficacy and toxicity of postoperative concomitant chemoradiation for patients with locally advanced [stages III and IV] but operable squamous cell carcinoma of head and neck region. Eligible patients had completely resected tumor and histological evidence of extracapsular spread of metastatic lymph node or positive surgical margins. The patients were randomized to receive postoperatively either conventional radiotherapy alone [60 Gy] or concomitant cisplatin [100 mg/m2] on day 1, 22 and 43 and radiotherapy [60 Gy]. A total of 37 patients were entered into this study. At a median follow up of 23.7 months in both groups, the locoregional failure rates at 2 years were 50% and 36.8% in radiotherapy and chemoradiotherapy arms, respectively. The difference was not statistically significant. Although the incidence of distant metastasis was reduced by the addition of chemotherapy but it was not statistically significant. The 2-year disease free survival and overall survival were 38.9% and 50% in radiotherapy group compared with 52.6% and 57.9% in chemoradiotherapy group. The differences were not statistically significant. The chemotherapy was satisfactorily well tolerated and did not affect the ability to deliver the radiotherapy. The most common treatment related toxicity was mucositis, in the combined group, 5 patients [26%] developed severe mucositis that necessitated treatment interruption versus only 2 patients [11%] in the RT group. The study concluded that postoperative concomitant cisplatin and radiotherapy for patients with high risk resectable locally advanced head and neck carcinoma improves the locoregional control, together with improvement in both the 2-year disease free and overall survival. This seems to be true despite of not reaching the 5% level of significance, which may be due to the relatively small sample size