Lancet: Chemo+RT bolsters head and neck cancer survival

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The use of chemotherapy concurrently with radiotherapy for patients with advanced head and neck cancer (who haven’t undergone previous surgery) reduces disease recurrence, the development of new tumors and death, according to a study published online Oct. 27 in the Lancet Oncology.

According to Jeffrey S. Tobias, MD, from the department of clinical oncology at University College Hospital in London, and colleagues head and neck cancers are “relatively common”—about 7,500 new cases annually in the United Kingdom and 45,000 in the United States—and are increasing in number in some countries because of smoking and excessive alcohol consumption.

The study was conducted by the U.K. Head and Neck Cancer Trialists’ Group and followed 966 patients who were recruited from 34 centers in the U.K.—as well as two centers from Malta and Turkey—between 1990 and 2000.

Patients with locally advanced head and neck cancer—who had not previously undergone surgery—were randomly assigned to four groups:

  • Those who underwent radiotherapy alone (233 patients);
  • Those who received two courses of non-platinum chemotherapy (SIM group) the same time as radiotherapy (166 patients);
  • Those who received chemotherapy (SUB group) after completing radiotherapy (160 patients); and
  • Those who received chemotherapy (SIM+SUB) both during and after radiotherapy (154 patients)

Patients who previously had surgery were randomly assigned to radiotherapy alone (135 patients) or SIM alone (118) groups.

Among patients who didn’t undergo previous surgery, the median survival rate was two to six years in the radiotherapy group alone, four to seven years in the SIM alone group, two to three years in the SUB alone group and two to seven years in the SIM+SUB group, the researchers said. The median event-free survival, which includes recurrence, new tumor or death, depending on what occurred first, was one year for the radiotherapy group, 2.2 years for the SIM alone group, one year for the SUB alone group and one year for the SIM+SUB group.

The authors determined that for every 100 patients given SIM alone, there are 11 fewer event-free survival events compared with 100 patients given radiotherapy 10 years after treatment.

For patients who had previously undergone surgery, the median overall survival rate was five years in the radiotherapy alone group and 4.6 years in the SIM alone group, with a corresponding event-free survival of 3.7 and three years respectively.

The percentage of patients who had experienced significant toxicity during treatment were 11 percent (radiotherapy alone), 28 percent (SIM alone), 12 percent (SUB alone) and 36 percent (SIM+SUB). Among those with previous surgery, the results were 9 percent (radiotherapy alone) and 20 percent (SIM alone). The most common toxicity during treatment was mucositis.

The researchers reported that patients who experienced significant toxicity at least six months after treatment were: 6 percent in the radiotherapy alone cohort; 6 percent in the SIM alone group, 4 percent in the SUB alone and 6 percent in SIM+SUB cohort among patients who had no previous surgery. In the group who had undergone prior surgery, 7 percent of the radiotherapy alone group and 11 percent of the SIM alone group reported significant toxicity. After six months the most common toxicity was xerostomia.

The authors concluded that patients with head and neck cancer who had undergone previous surgery didn’t benefit from the addition of chemotherapy to post-operative radiotherapy. But, they did find that there was a benefit in terms of recurrences and deaths in the case of patients (who hadn’t undergone previous surgery) given two courses of non-platinum chemotherapy simultaneously with radiotherapy, and that this benefit persisted even after a long follow-up period.

“[T]he availability of a relatively simple, inexpensive and low-toxicity chemoradiation regimen considerably improves the likelihood of completing treatment, essential for improving the chance of cure,” Tobias and colleagues wrote.