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Mature results from a randomized Phase II trial of cisplatin plus 5‐fluorouracil and radiotherapy with or without tirapazamine in patients with resectable Stage IV head and neck squamous cell carcinomas
Author(s) -
Le QuynhThu,
Taira Al,
Budenz Sherie,
Jo Dorie Mary,
Goffinet Don R.,
Fee Willard E.,
Goode Richard,
Bloch Daniel,
Koong Albert,
Martin Brown J.,
Pinto Harlan A.
Publication year - 2006
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/cncr.21785
Subject(s) - tirapazamine , medicine , regimen , chemoradiotherapy , fluorouracil , cisplatin , radiation therapy , chemotherapy , lymph node , survival rate , oncology , induction chemotherapy , stage (stratigraphy) , surgery , biochemistry , chemistry , cytotoxicity , in vitro , paleontology , biology
BACKGROUND The objective of this article was to report the results from a randomized trial that evaluated the efficacy and toxicity of adding tirapazamine (TPZ) to chemoradiotherapy in the treatment of patients with head and neck squamous cell carcinomas (HNSCC). METHODS Sixty‐two patients with lymph node‐positive, resectable, TNM Stage IV HNSCC were randomized to receive either 2 cycles of induction chemotherapy (TPZ, cisplatin, and 5‐fluorouracil [5‐FU]) followed by simultaneous chemoradiotherapy (TPZ, cisplatin, and 5‐FU) or to receive the same regimen without TPZ. Patients who did not achieve a complete response at 50 Grays underwent surgical treatment. Stratification factors for randomization included tumor site, TNM stage, and median tumor oxygen tension. The primary endpoint was complete lymph node response. RESULTS The addition of TPZ resulted in increased hematologic toxicity. There was 1 treatment‐related death from induction chemotherapy. The complete clinical and pathologic response rate in the lymph nodes was 90% and 74% for the standard treatment arm and the TPZ arm, respectively ( P = .08) and 89% and 90% at the primary site in the respective treatment arms ( P = .71). The 5‐year overall survival rate was 59%, the cause‐specific survival rate was 68%, the rate of freedom from recurrence was 69%, and the locoregional control rate was 77% for the entire group. There was no difference with regard to any of the outcome parameters between the 2 treatement arms. The significant long‐term toxicity rate also was found to be similar between the 2 arms. CONCLUSIONS The addition of TPZ increased hematologic toxicity but did not improve outcomes in patients with resectable, Stage IV HNSCC using the protocol administered this small randomized study. The combination of induction and simultaneous chemoradiotherapy resulted in excellent survival in these patients. Cancer 2006. © 2006 American Cancer Society.