The efficacy and safety of concurrent chemoradiotherapy for maxillary sinus squamous cell carcinoma patients.

OBJECTIVE: Combined treatment modality, e.g., definitive surgery followed by radiotherapy (RT) and definitive RT with concurrent chemotherapy, has been applied for advanced maxillary sinus squamous cell carcinoma (MSSCC) patients to obtain a better survival with organ preservation in Japan. METHODS: The outcome of 40 patients with MSSCC between 1991 and 2007 in our institute was analyzed retrospectively. There were 36 males and 4 females, the average age being 59.5 years (ranging from 34 to 81 years). The median follow-up time was 66.1 months. All the patients had received a combined treatment consisting of definitive surgery, RT, and intra-arterial or systemic chemotherapy. The chemotherapeutic regimen was different depending on the performance status and/or complications of the patients. Since 1998, concurrent chemoradiotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin regimen (CCRT-PFML) instead of neo-adjuvant chemotherapy has been applied. RESULTS: The overall 5-year survival rate was 59.2%, the 5-year disease-specific survival rate was 71.7%, and the 5-year organ preservation survival rate was 42.4%. In the group receiving CCRT-PFML, the overall 5-year survival rate was 60.0%, the 5-year disease-specific survival rate was 76.0%, and the 5-year organ preservation survival rate was 60.3%. CONCLUSION: CCRT-PFML for advanced MSSCC patients is feasible to preserve the organs without reducing the survival rate.

[Concurrent chemoradiotherapy for squamous cell carcinoma of the oropharynx].

Subjects were 34 patients, 32 men and 2 women, with squamous cell carcinoma of the oropharynx, with a median age of 63 years (range, 47 to 72 year). Subsites were the lateral wall in 18, anterior wall in 10, posterior wall in 5 and superior wall in 1. Nine had stage III disease and 25 had stage IV disease. Nineteen cases were resectable and 15 cases were unresectable. The patients were treated with concurrent chemoradiotherapy. The treatment regimen consisted of 5-fluorouracil (5-FU) and cisplatin (CDDP). 5-FU was given at 1000mg/m2 per day as a continuous infusion over 4 days, and CDDP was given at 60mg/m2 on day 4 after the start of 5-FU administration. Two courses of chemotherapy were administered, on day 1 and day 35. Radiation was given at a single daily fraction of 2Gy and 5 fractions per week were administered up to a total dose of 58 to 70Gy. Radiation break was scheduled from day 26 to 35. The median total delivered dose of radiation was 66Gy. Toxicities included mucositis (grade 3, 23.6%, grade 4, 38.2%), vomiting (grade 3, 14.7%) and leukopenia (grade 3, 20.6%). Twenty-eight patients (82.3%) received the treatment as scheduled. Seven (22.6%) showed a complete response and 22 (70.9%) showed partial response. The mean overall survival rate was 23 months (4.5-73.5) and progression-free survival (PFS) rate was 20 months (4.5-71.3). The two-year preservation rate of the oropharynx without recurrence was 45.0%. The two-year overall survival (OS) rate was 57.1% and PFS rate was 55.1%. Significant differences among groups were observed in the two-year overall survival and progression-free survival rate, as follows: 84.6% and 88.8%, respectively, in the resectable cases, and 33.3% and 26.7%, respectively, in the unresectable cases, and 60.6% and 63.2%, respectively, in the T2 + 3 cases and 40.0% and 0%, respectively in the T4 cases. Failure patterns were noted in 15 cases with locoregional recurrence in 14 and other disease in one. Based on the results it is concluded that concurrent chemoradiotherapy is effective for preserving the oropharynx in a high percentage of patients and for improving the two-year OS and PFS rates without compromising the QOL.

[Clinical application of real-time tissue elastography to head and neck cancer--evaluation of cervical lymph node metastasis with real-time tissue elastography].

Real-time tissue elastography (elastography) is a new ultrasonography procedure that display tissue elasticity. We evaluated the usefulness of elastography in the diagnosis of cervical lymph node metastasis and its treatment results in patients with head and neck cancer. Metastatic lymph nodes tended to produce little distortion when displayed as hard tumors, and produced distortion, displayed as soft tumors, after radiation therapy and/or chemotherapy. Elastography thus is useful as a potential new diagnostic procedure in the diagnosis of neck lymph node metastasis in head and neck cancer.

[Adjuvant chemotherapy (nedaplatin/UFT) after concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma].

To evaluate the efficacy of adjuvant chemotherapy after concurrent chemoradiotherapy, 41 previously untreated patients with locally advanced and resectable head and neck squamous cancer were enrolled in a study to compare adjuvant chemotherapy (Nedaplatin/UFT) after concurrent chemoradiotherapy (CDDP/5-FU) and concurrent chemoradiation alone. Nine of the patients had stage III tumors and 32 had stage IV tumors. The primary tumor site was the hypopharynx in 14 patients, the larynx in 12 patients, the oral cavity in 9 patients, and the oropharynx in 6 patients. Treatment consisted of 6 courses of Nedaplatin (80 mg/m2) repeated at 4-week intervals and one year of the oral administration of UFTE (400 mg/day) after concurrent chemoradiotherapy at an outpatient clinic. Toxicities included leukopenia (grade 3, 15.4%) and thrombocytopenia (grade 3, 7.7%). One death from a gastric ulcer occurred. The median overall survival time was 30.1 months (5.5-50.1 months) for the adjuvant chemotherapy group and 21.7 months (4.0-48.8 months) for the control group. The progression-free survival period was 22.8 months (5.6-33.9 months) for the adjuvant chemotherapy group and 26.5 months (5.6-33.9 months) for the control group. The two-year overall survival rate was 73.3% for the adjuvant chemotherapy group and 55.7% for the control group. A significant difference was observed in the two-year progression-free survival rates: 66.9% for the adjuvant chemotherapy group and 27.8% for the control group (p = 0.03290). Among the patients with a partial response to concurrent chemoradiotherapy, in particular, a significant difference in the two-year progression-free survival rates was seen : 59.3% for the adjuvant chemotherapy group and 15.3% for the control group (p = 0.01102). The rate of loco-regional failure was 29.6% for the adjuvant chemotherapy group and 64.3% for the control group (p = 0.0716). Distant metastasis was not detected in either group. The rate of organ preservation was 66.7% for the adjuvant chemotherapy group and 35.7% for the control group (p = 0.1183). This adjuvant chemotherapy regimen might improve the loco-regional control rates after concurrent chemoradiotherapy.