Regional control after concomitant chemoradiotherapy without planned neck dissection in node-positive head and neck squamous cell carcinomas

Abstract

dissection in node-positive head and neck squamous cell carcinomas. AbstractObjectives: Although three-weekly high-dose (100mg/m 2 ) cisplatin (three cycles) chemoradiotherapy has been considered a standard regimen for patients with advanced head and neck squamous cell carcinomas (HNSCC), this protocol is associated with significant acute and late toxicities. Therefore, weekly cisplatin at a dose of 40mg/m 2 has been used at our institution since 2006. This retrospective study was aimed at assessing the oncologic efficacy of weekly cisplatin chemoradiotherapy for the control of nodal metastasis.Methods: We analyzed 28 patients with node-positive HNSCC treated with weekly cisplatin and concurrent radiotherapy. Computed tomography was performed 4-8 weeks after the completion of chemoradiotherapy to evaluate nodal response. If residual neck disease was apparent or suspected, we performed early salvage neck dissection (ND). In cases with a complete response (CR), we took a " wait and see " approach.When no viable tumor cells were observed in the surgical specimens obtained by ND, nodal metastasis was defined as controlled by weekly cisplatin chemoradiotherapy alone.Results: Nodal metastasis was evaluated as having a CR in 20 patients (71%). Eight patients (29%) underwent early salvage ND. Recurrent primary tumors were observed in the other four patients (14%). Salvage primary resection and associated ND were performed for these four patients.In 7 of 12 patients undergoing ND, no viable tumor cells were observed. In 23 of 28 patients, neck diseases were controlled by chemoradiotherapy alone (not including salvage by ND). In 27 of 28 patients, neck diseases were controlled by the overall treatment (including salvage by ND). The rate of nodal control by chemoradiotherapy alone and by the overall treatment was found to be 82.0% and 96.3%, respectively, using the Kaplan-Meier method.The three-year overall and disease free survival rates were 86.8% and 80.8%, Although three-weekly high-dose (100mg/m 2 ) cisplatin (three cycles) and radiotherapy has been considered a standard regimen for patients with advanced HNSCC, this protocol is associated with significant acute and late toxicities [1][2][3][4]. Furthermore, the completion rate for this regimen is relatively poor [1][2]. Therefore, weekly cisplatin at a dose of 40mg/m 2 has been used at our institution since 2006. We reported that weekly cisplatin was easier to manage than three-weekly cisplatin, because patients could be monitored more regularly for toxicity, thereby allowing the schedule to be altered if required [5]. This retrospective study was aimed at assessing the oncologic efficacy of concomitant weekly cisplatin chemoradiotherapy without planned neck dissection (ND) for the control of neck disease. MATERIAL AND METHODSPatients. Between July 2006 and May 2011, 59 patients with biopsy-proven HNSCC were treated with concurrent weekly cisplatin chemoradiotherapy. Twenty-two patients with N0, seven patients who underwent neo-adjuvant chemotherapy (using cisplatin,...

Treatment outcomes of radiotherapy with concurrent weekly cisplatin in older patients with locally advanced head and neck squamous cell carcinoma

“…The present study focused on patients aged ≥ 70 years, and the overall incidence of acute adverse events was similar to that reported in previous retrospective studies of weekly CDDP + RT [12,14,15,18]. It should be noted that from a radiotherapy perspective, more recently published studies may include more cases treated with IMRT or proton beam therapy, and have an advantage regarding adverse events.…”

“…They analyzed 65 patients with a median age of 55 years who underwent CRT and reported a 5-year OS rate of 56% and a 5-year PFS rate of 39%. In another retrospective series that included older adults, the 3-year OS was reported to be around 63.0–86.8% [ 12 – 15 ]. In our study, which included only patients aged ≥ 70 years, the 3-year OS rate was 80.9%.…”

Comparison of acute toxicities associated with cetuximab-based bioradiotherapy and platinum-based chemoradiotherapy for head and neck squamous cell carcinomas: A single-institution retrospective study in Japan

“…However, this intensive chemoradiotherapy is associated with significant acute and late toxicity [1][2][3][4]. In our institution, weekly cisplatin regimen (40mg/m 2 ) has been used for chemoradiotherapy since 2006 [5,6]. The feasibility of this regimen has been examined by Japan Clinical…”