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Alternating chemoradiotherapy versus partly accelerated radiotherapy in locally advanced squamous cell carcinoma of the head and neck
Author(s) -
Corvò Renzo,
Benasso Marco,
Sanguineti Giuseppe,
Lionetto Rita,
Bacigalupo Almalina,
Margarino Giovanni,
Pallestrini Eugenio,
Merlano Marco,
Vitale Vito,
Rosso Riccardo
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20011201)92:11<2856::aid-cncr10132>3.0.co;2-6
Subject(s) - medicine , radiation therapy , chemoradiotherapy , head and neck cancer , concomitant , larynx , surgery , stage (stratigraphy) , carcinoma , chemotherapy , survival rate , urology , paleontology , biology
BACKGROUND The authors previously have found that in patients with locally advanced squamous cell carcinoma of the head and neck (SCC‐HN), alternating chemoradiotherapy (ALT) was superior to low‐total‐dose conventional radiotherapy alone. The purpose of this randomized trial was to compare the same chemoradiotherapy approach with high‐total‐dose partly accelerated radiotherapy. METHODS During 6 years, 136 consecutive patients with previously untreated unfavorable Stage II or Stage III–IV (International Union Against Cancer) SCC of the oral cavity, pharynx, and larynx were enrolled. They were randomly assigned to chemotherapy consisting of 4 cycles of intravenous cisplatin (20 mg/m 2 of body surface area per day for 5 consecutive days) and 5‐fluorouracil (200 mg/m 2 per day for 5 consecutive days; weeks 1, 4, 7, and 10) alternated with three 2‐week courses of radiotherapy (20 grays [Gy] per course, 2 Gy per day, 5 days per week; ALT, 70 patients) or to partly accelerated radiotherapy with final concomitant boost technique (75 Gy/40 fractions in 6 weeks; partly accelerated radiotherapy [PA‐RT], 66 patients). RESULTS At the median follow‐up of 60 months (range, 30–102 months), no statistical differences were observed in overall survival, progression free survival, or locoregional control between the 2 treatments. Actuarial 3‐year overall survival and progression free survival were 37% and 35%, respectively, in the ALT group and 29% and 27%, respectively, in PA‐RT group. The median overall survival and progression free survival were 24 and 15 months, respectively, in the ALT arm and 18 and 11 months, respectively, in PA‐RT arm. Actuarial 3‐year locoregional control rates were 32% in the ALT group and 27% in the PA‐RT group. At multivariate analysis, tumor classification was the only factor that emerged as a significant independent variable affecting overall survival. Patients treated in the PA‐RT arm experienced higher Grade 3+ (World Health Organization) acute skin and mucosal reactions than patients in the ALT arm. Moreover, local late mucosal and skin toxicities occurred more often in patients treated with PA‐RT. CONCLUSIONS This trial failed to disclose statistically significant differences in the outcome of patients treated with either ALT or PA‐RT. Therefore, definitive conclusions could not be made. However, acute skin effects and late mucosal and skin toxicities above the clavicles appeared to be significantly lower with chemoradiotherapy. Cancer 2001;92:2856–67. © 2001 American Cancer Society.