[Combined radiotherapy with cis- or carboplatin in advanced head and neck tumors]

This report reviews the treatment results of 111 patients with stage T3-4, N0-3, M0, biopsy proven squamous cell carcinoma of the oropharynx and oral cavity. All patients were treated by primary irradiation with 1.8 to 2 Gy per day for five days a week up to a target volume dose of 39.6 or 40 Gy. Simultaneously 20 mg/m2 cisplatin was given under hyperhydration and mannitol diuresis on days 1 to 5. In case of partial tumour regression radiotherapy was continued up to 70 Gy with another course of cisplatin. In case of minor response surgery was interposed followed by subsequent irradiation with 30 Gy and a second course of cisplatin. 67% of the patients showed an initial complete tumour involution and 27% a partial response. The five year actuarial survival rate with a minimum follow-up of two years is 47.6%. More than 96% of the long term survivors showed a complete response after the end of treatment. The results demonstrate that concomitant radiation and chemotherapy with cisplatin is a highly effective treatment in advanced head and neck carcinoma with tolerable toxicity. Carboplatin (CBDCA) is a second generation platinum analog and has shown comparable antitumour activity but less nephro- and neurotoxicity than cisplatin in head and neck cancer. In order to determine the feasibility and efficacy of simultaneous application of CBDCA and radiotherapy a phase I-II study is going on. Between September 1987 and March 1988 30 patients with advanced squamous carcinoma of the head and neck (T3-4, N0-3) have entered this trial. Patients were separated into three groups which received 60 mg/m2. 70 mg/m2 and 80 mg/m2 CBDCA from days 1 to 5 and 28 to 32. Radiotherapy was administered up to a target absorbed dose of 70 Gy. 5 X 2 Gy/week in shrinking field technique. The group which received 80 mg/m2 CBDCA reached the myelotoxicity limit so that subsequent patients were treated with 70 mg/m2. Among 30 patients who completed the treatment, 22 showed a complete (CR) and eight a partial remission (PR). Despite the short follow-up period the preliminary results appear to be comparable with those achieved after combined radiotherapy and cis-DDP application without any limitations for patients with renal or cardiovascular disorders.