Analysis of feasibility and toxicity of concurrent chemoradiotherapy with S-1 for locally advanced squamous cell carcinoma of the head and neck in elderly cases and/or cases with comorbidity

Abstract

Purpose The aim of this study was to evaluate the feasibility and toxicity of concurrent chemoradiotherapy (CCRT) with S-1 in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) in elderly cases and/or cases with comorbidity. Methods Fifty eligible patients with stage III (15 cases) or stage IV (35 cases) SCCHN were treated with CCRT. Thirteen cases had an advanced age of over 75 years and 37 cases had comorbidity. Definitive radiotherapy was delivered up to a total dose of 66-70.2 Gy. The patients received two courses of oral S-1 (40 or 50 mg twice a day [80 or 100 mg/day]) for 2 weeks followed by 1 week of rest while receiving CCRT. Results All the patients received the planned radiotherapy and at least one course of S-1. Grade 3 mucositis occurred in 20% of the patients (10/50). Grade 3 neutropenia occurred in 12% (6/50) and leukocytopenia occurred in 6% (3/50) of the cases. Pathologically, the complete response rates were 93% in stage III and 54% in stage IV. Conclusion Concurrent chemoradiotherapy with S-1 is a safe, well-tolerated and effective regimen for locally advanced SCCHN in elderly cases and/or cases with comorbidity.

Gimeracil, a component of S-1, may enhance the antitumor activity of X-ray irradiation in human cancer xenograft models in vivo

“…Preliminary clinical studies have demonstrated the potential efficacy of chemoradiotherapy with S-1 and radiation in treating locally advanced head and neck and pancreatic cancers (26,27).…”

Phase I Study of Oral S-1 and Concurrent Radiotherapy in Patients with Head and Neck Cancer

“…Sato et al reported that the RD of S-1 was 65 mg/m 2 /day when radiation was given to a total dose of 60 Gy and S-1 was administered every day for 2 weeks and then was suspended for 1 week [16]. In addition, Tsukuda et al reported that the RD of S-1 was 80-100 mg/body/day when radiation was given to a total dose of 60-70.2 Gy, and S-1 was administered every day for 2 weeks and was then suspended for 1 week [17]. Furthermore, Harada et al reported the results of an S-1 dose escalation study that had almost the same schedule as our study.…”

“…The difference from our study is that their total radiation dose was only 40 Gy because they were giving preoperative concurrent chemoradiotherapy. There have been other reports on Phase III trials of radiotherapy with S-1 [19][20][21][22][23] or the combination of S-1 and cisplatin/nedaplatin [24][25][26] for head and neck cancer. These studies have demonstrated that S-1 and concurrent radical radiotherapy is safe and well tolerated by patients with complications and is a patient-friendly treatment.…”

Induction Therapy with S-1 for Spindle Cell Carcinoma of the External Auditory Canal

“…There have been several reports about the administration of S-1 as adjuvant chemotherapy for head and neck cancer. One report recommended that S-1 should be administered at a dose of 60 mg/m 2 /day for 5 days, followed by 2 days off, in combination with irradiation (total dose: 64-70 Gy) for 6-7 weeks [12], while another study recommended that S-1 should be administered every day at a dose of 80-100 mg/body/day for 2 weeks and then suspended for 1-2 weeks to allow radiotherapy to be performed (total dose: 60-70.2 Gy) [13,14]. On the basis of the results of these studies, we chose a treatment regimen in which S-1 was delivered at a dose of 80 mg/body/day every day for 2 weeks before surgery.…”