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• W4256706983 abstract "Accelerated radiotherapy in the treatment of headsneck malignancies improves disease specific survival(1). Platinum based chemotherapy may provide additional survival benefit(2). The aim of this prospective, non-randomised, single institution feasibility study was to investigate whether the addition of platinum chemotherapy to an accelerated radiotherapy regimen is possible without adding significantly to toxicity. Survival analysis will also be presented. Twenty-one patients with locally advanced squamous cell carcinoma of the headsneck were treated with combined chemotherapysradiotherapy. Radical radiotherapy was prescribed to a total dose of 66Gy in 33 fractions according to Danish HeadsNeck Cancer Study Group (DAHANCA) guidelines(1). Patients received conventional 2 Gy fractions of treatment daily Monday to Friday, with an extra fraction on one day a week with a minimum 6 hour gap between these treatments. Overall treatment time was 38 days. Cisplatin chemotherapy (75mg/m2) with hydration was scheduled for day 1 and 22 of radiotherapy. All patients were WHO performance score 0 or 1, with no contraindication to radical treatment and normal baseline haematological, liver and kidney function. Average patient age was 59 years (range 44 to 70 years). 86% male. Site of primary tumour: oropharynx 42%, larynx 38%, oral cavity 10%, hypopharynx 10%. Staging: 10% Stage II, 24% stage III, 52% stage IVA and 14% stage IVB. 17 patients received neo-adjuvant chemotherapy with cisplatins5-fluorouracil. 95.2% patients completed radiotherapy as planned. Average overall treatment time was 39.8 days. All patients received day 1 cisplatin chemotherapy. 5 patients (23.8%) did not receive day 22 treatment. Haemoglobin was maintained at >12g/dl throughout radiotherapy (47% received a blood transfusion). 4 episodes of grade 3 and 1 episode of grade 4 neutropaenia were documented. None of these episodes were associated with infection requiring intervention. One patient died of type II respiratory failure while on treatment. One patient developed acute renal failure, not requiring dialysis, resolving with conservative management. 67% of patients are currently alive and free of disease. Median survival is not achieved to date. No statistically significant difference on subgroup analysis for tumour stage or use of neo-adjuvant chemotherapy. Two patients have also developed non-small-cell lung carcinoma, considered to be second malignancy rather than metastatic. Two patients have died as a consequence of recurrent headsneck carcinoma. Patients experienced significant acute morbidity with treatment: 67% patients required admission for symptom control, with an average inpatient stay of 17 days (range 2 to 65 days). At 2 year follow-up, 4.7% (1 patient) has osteoradionecrosis of the mandible, 23.8% have chronic facial pain requiring regular analgesia, and >50% have >grade 2 skin fibrosis. Additional complications include trismus, xerostomia and continuing dependency on percutaneuous nutrition. The addition of platinum chemotherapy to accelerated radiotherapy is feasible. Disease free survival in this small non-randomised study is 67% at 2 years. Acute toxicity is significant and requires intensive medical and nursing support. Combining chemotherapy with accelerated radiotherapy should be undertaken with caution and in the context of clinical studies. Additional analysis of patient quality of life with these treatments should be performed, particularly with reference to late morbidity." @default.
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• W4256706983 date "2004-09-01" @default.
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• W4256706983 title "Combined chemotherapy with accelerated radiotherapy in the radical management of locally advanced headsneck malignancy. A feasibility study" @default.
• W4256706983 doi "https://doi.org/10.1016/s0360-3016(04)01751-1" @default.
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