Concomitant chemoradiotherapy for advanced head and neck cancer

Head and neck cancer is mostly curable in the early stages by either surgery or radiotherapy alone, but the control rate for advanced stages is low, even with combined surgery and postoperative radiotherapy. From September, 1990, to January, 1992, 35 patients with locoregionally advanced head and neck cancers were entered in a prospective study of concomitant chemoradiotherapy. Thirty-three completed the treatment. There were 29 males and four females with a median age of 53 years. All except one patient were in stage IV. Radiotherapy was delivered using a telecobalt unit and by conventional fractionation (1.8 Gy/fraction, 5 fractions/wk). Chemotherapy with cisplatin (10 mg/m2/day, daily, days 1-5) and 5-FU (500 mg/m2/day continuously infused for five days) was given concurrently during the first and fifth weeks of radiation. Twenty-four among 31 eligible patients achieved complete response (77.4%) and the other seven (22.6%) partial response, resulting in a 100% response rate. The toxicities experienced were increased compared with those caused by radiotherapy alone. The most common side effects were gastrointestinal and hematologic toxicities but the whole treatment was well tolerated. The two-year actuarial survival rate is 45%. We found the primary origin and overall treatment time to affect survival significantly. The survival rate for tumors arising from the nasopharynx or paranasal sinus is better than for those arising from other regions of the head and neck. The shorter treatment times (within eight weeks) had a better survival rate. Our preliminary experience suggests that concomitant chemoradiotherapy is both feasible and effective for head and neck cancer. The optimal scheduling and dosage of concomitant chemoradiotherapy should be further researched.