gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Comparison of Two Radiochemotherapy (RCT) Schedules for Locally Advanced Squamous Cell Head and Neck Cancer

Meeting Abstract

  • corresponding author presenting/speaker Silke Tribius - Universitatsklinikum Hamburg-Eppendorf, Deutschland
  • Thomas Schneider - Universitatsklinikum Hamburg-Eppendorf
  • Mashid Sheikh-Sarraf - Universitatsklinikum Hamburg-Eppendorf
  • Steven E. Schild - Mayo Clinic Scottsdale, USA
  • Winfried Alberti - Universitatsklinikum Hamburg-Eppendorf
  • Dirk Rades - Universitatsklinikum Hamburg-Eppendorf

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO252

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 20. März 2006

© 2006 Tribius et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: RCT is the standard therapy in many centers for locally advanced unresectable head and neck cancer. The optimal schedule is debated. 3 courses of 100 mg/m2 cisplatin may be considered the “standard” schedule. Its acute toxicity is serious including treatment related death. Thus, a less toxic and similarly effective schedule is desired. This study compares “standard” RCT and 2 courses of fractionated cisplatin (20 mg/m2 d 1-5+29-33) and 5-FU (600 mg/m2 d 1-5+29-33) for definitive treatment of locally advanced head and neck cancer for toxicity and outcome.

Materials and Methods: 116 patients with unresectable stage III/IV head and neck cancer (squamous cell carcinoma), treated 1/00-6/05, were included (tumor site: 48 oropharynx, 25 oral cavity, 27 hypopharynx, 16 larynx). The total RT dose was 70 Gy (2 Gy per fraction). The patients were divided in 2 groups according to the chemotherapy schedule: 100 mg/m2 cisplatin on d 1, 22, 43 of RT (group A, n=54), versus 20 mg/m2 cisplatin and 600 mg/m2 5-FU on d 1-5+29-33 of RT (group B, n=62). Both schedules were compared for toxicity and for outcome in terms of overall survival (OS), metastatic-free survival (MFS), and loco-regional control (LC). Further potential prognostic factors were evaluated for outcome: age, sex, ECOG performance status, tumor site, histologic grading, T-stage, N-stage, AJCC-stage, hemoglobin before RT, and completion of chemotherapy.

Results: Both treatments were comparable for 2 year-LC (group A: 73% vs. group B: 68%, P=0.44), 2 year-MFS (70% vs. 64%, P=0.65), and 2 year-OS (56% vs. 53%, P=0.72). Acute toxicity was more severe in group A, especially °3-4 nausea/vomiting (24% vs. 6%, P=0.025), °2-3 nephrotoxicity (13% vs. 2%, P=0.047) and °3-4 hematotoxicity (31% vs. 15%, P=0.076). At least one °3-4 chemotherapy-related toxicity occurred in 46% and 21% (P=0.027). 43% group A patients and 9% group B patients did not complete chemotherapy due to toxicity (P=0.019). °2-3 late toxicity was similar in both groups (69% vs. 72%, P=0.89). On multivariate analysis, the outcome was significantly associated with performance status, T-stage, and completion of chemotherapy.

Conclusions: For definitive radiochemotherapy of locally advanced head and neck cancer, 2 courses of fractionated cisplatin (20 mg/m2/day) and 5-FU appear preferable, as this schedule resulted in similar outcome as 3 courses cisplatin (100 mg/m2/day), but was associated with significantly less acute toxicity.