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Simultaneous versus sequential combined technique therapy for squamous cell head and neck cancer.
D J Adelstein1, V M Sharan, A S Earle
1Department of Medicine, Cleveland Metropolitan General Hospital, Ohio.
Cancer
|April 15, 1990
Summary
Simultaneous (SIM) chemoradiotherapy for head and neck cancer shows better relapse-free survival than sequential (SEQ) treatment. SIM therapy also improved complete response rates, potentially avoiding surgery for some patients.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Oncology
Background:
- Head and neck squamous cell carcinoma (HNSCC) is a significant global health challenge.
- Combined modality treatment involving chemotherapy and radiation is a standard approach for locally advanced HNSCC.
- Optimizing the sequence of chemotherapy and radiation is crucial for improving treatment outcomes.
Purpose of the Study:
- To compare the efficacy and toxicity of simultaneous (SIM) versus sequential (SEQ) chemoradiotherapy in patients with locally confined squamous cell head and neck cancer.
- To evaluate the impact of treatment schedule on complete response rates, need for surgery, and survival outcomes.
Main Methods:
- Prospective randomized trial involving 48 patients with M0 squamous cell head and neck cancer.
- Treatment arms: SIM (5-fluorouracil infusion, cisplatin bolus, and radiation therapy concurrently) vs. SEQ (induction chemotherapy followed by radiation therapy).
- Patients with residual disease underwent surgery; those with complete response did not. Follow-up ranged from 9 to 41 months.
Main Results:
- Toxicities were similar, except for more severe mucositis and weight loss in the SIM arm (P=0.002).
- Relapse-free survival was significantly better in the SIM arm (7 failures) compared to the SEQ arm (14 failures) (P=0.03).
- Complete response rates after induction were higher with SIM (P=0.02), and complete response correlated with improved relapse-free and overall survival (P=0.0005 and P=0.05, respectively).
- Eighteen patients avoided surgery due to complete response after induction therapy, with no compromise in relapse-free survival.
Conclusions:
- Simultaneous chemoradiotherapy demonstrates a significant advantage in relapse-free survival for head and neck cancer patients compared to sequential treatment.
- The SIM schedule enhances complete response rates, potentially reducing the need for post-treatment surgery.
- While overall survival benefits are not yet statistically significant, the improved relapse-free survival and organ preservation warrant further investigation.