Intensive Concurrent Chemoradiotherapy for Head and Neck Cancer with 5-Fluorouracil- and Hydroxyurea-Based Regimens: Reversing a Pattern of Failure

Abstract

Combined modality programs that were developed over the past two decades demonstrated that the nonsurgical therapy of locoregionally advanced head and neck cancer is feasible and produces survival outcomes that are at least comparable with surgery. The systemic therapy of head and neck cancer has gained momentum in recent years. Several randomized studies have shown that the concurrent administration of chemotherapy and radiation therapy is superior to radiation therapy alone. Medicine, 676 North St. Clair Street, Suite 850, Chicago, Illinois 60611, USA. Telephone: 312-695-6180; Fax: 312-695-6189; e-mail: aargiris@northwestern.edu Received December 10, 2002; accepted for publication April 21, 2003. ©AlphaMed Press 1083-7159/2003 The Oncologist ® LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the results of multicenter trials with chemoradiotherapy with 5-FU-and hydroxyurea-based regimens for the treatment of locoregionally advanced head and neck cancer.2. Explain the rationale for the combination treatment of radiation, 5-FU, and hydroxyurea.3. Recognize the toxicities and potential functional impairment for patients treated with aggressive concurrent chemoradiotherapy.4. Discuss the experimental role of induction chemotherapy in the management of locoregionally advanced head and neck cancer.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S.

Chemoradiotherapy for locoregionally advanced squamous cell carcinoma of the base of tongue

“…5,30 However, because altered-fractionation multiagent chemoradiotherapy platforms have high locoregional control rates, distant metastases occur more frequently than local failure. 8,31 In many phase II trials of induction chemotherapy before definitive chemoradiotherapy, high rates of distant control as well as locoregional control are seen. 14,32,33 In this study, there was a trend to better 5-year OS with induction chemotherapy (64% vs 50%; p ¼ .11) and both local failure and distant metastases were infrequent.…”

“…A dominant pattern of failure seen in our series was distant metastases, a relationship that has been noted in previous studies of FHX-based chemoradiotherapy. 8 One hypothesis is that decreasing distant failure requires improved systemic therapy. Future trials of chemoradiotherapy plus molecular targeted therapy may be warranted for high-risk disease in the adjuvant setting and is warranted in the setting of organpreservation for locally advanced disease.…”

“…6,7 Previous studies from our institution have demonstrated the combination of 5-fluorouracil (5-FU), hydroxyurea, and RT (FHX) is an effective regimen for locoregionally advanced head and neck cancer. 8 The present study was undertaken to report the outcomes of patients treated definitively or adjuvantly with concurrent FHX-based chemoradiotherapy for BOT cancers and to compare our experience with the pertinent literature.…”

Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

“…The pattern of failure in which we see more distant metastasis (4 patients) compared with regional failure (2 patients) in this cohort is consistent with the trend seen in recent trials employing concurrent chemoradiotherapy. 11,12,37 Chemotherapy in addition to bilateral neck irradiation could explain the very low rate of emergence of the primary tumor as well as lower rate of second primary appearance. Series with adjuvant bilateral neck irradiation reported emergence of the primary tumor in 7% to 20% of patients.…”

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

“…7 The utility of split-course, hyperfractionated, FHX-based CRT regimens in patients with stage IV disease has been reported in sequential phase I and II trials enrolling more than 400 patients. 8 Thus it appeared feasible and efficacious to develop the FHX regimen administering twice-daily RT in intermediate-stage disease with the goal of improving LC, reducing the need for salvage surgery, and positively influencing survival. In addition, three quality-of-life (QOL) instruments were administered to all patients.…”