Use of an abridged radiation therapy could reduce amounts of chemotherapy and toxicity in patients with advanced head and neck cancers, according to a study presented by Phuc Felix Nguyen-Tan, MD, Feb. 26 at the Multidisciplinary Head and Neck Cancer symposium.
Nguyen-Tan, MD, of University of Montreal Hospital Centre (CHUM) Notre-Dame in Montreal, and colleagues compared the efficacy and toxicity of combining cisplatin with an accelerated concomitant boost (AFX-C) and standard fractionation (SFX) in patients with advanced head and neck carcinoma (LA-HNC).
The randomized phase III trial evaluated 721 patients: 360 patients with AFX-C and 361 patients with SFX who received two and three cycles of cisplatin, respectively. Patients had a median age of 56 and had both stage III and IV cancer of the oral cavity, oropharynx, hypopharynx or larynx.
Results showed that after a mean follow-up period of 4.8 years, 418 patients were still alive. When observing the primary endpoint—overall survival rate—researchers found that the rates for patients who received accelerated radiation and those who received standard radiation were 59 and 56 percent, respectively.
In addition, the researchers also recorded disease-free survival rates, local-regional failure and metastasis rates in patients. These rates for patients treated with AFX-C and SFX were: 45 and 44 percent, 31 and 28 percent and 18 and 22 percent, respectively.
"Accelerated fractionation concurrent with two doses of high dose cisplatinum has the potential to reduce toxicity related to the chemotherapy regimen by not exposing patients to a third cycle," wrote Nguyen-Tan.
Nguyen-Tan et al found that patients who received SFX with cisplatin greater or equal to amounts of 160 mg/ m2 had a better survival rate than those who received less. However, the authors noted that “there was no striking trend in the SFX subset between patients receiving 240-300 and 160-210 mg/ m2 of cisplatin.”
The trial was conducted between July 2002 and May 2005 and according to the authors, chemotherapy toxicities were measured using Common Toxicity Criteria (CTC) 2.0 and endpoints were estimated using the Kaplan-Meier method.