Encouraging Australian experience with postoperative chemotherapy and radiotherapy in head and neck cancer

This paper published in the International Journal Radiation Oncology Biology and Physics described the initial experience with combined postoperative chemotherapy and radiotherapy in head and neck cancer from the Peter MacCallum Cancer Centre. Locoregional control (LRC) of head and neck cancer with postoperative radiotherapy varies from 30 -70% depending on a variety of risk factors. Data suggests that concurrent chemoradiotherapy may be effective for definitive and postoperative treatment of these cancers.From July 1999 to January 2003, 47 patients with high-risk head and neck squamous cell carcinoma were treated with a combination of cisplatin 40 mg/m2 weekly for six weeks with postoperative radiotherapy. Carboplatin (AUC 2) was used in 20 patients thought to be unsuitable for cisplatin.The dose of radiotherapy was 60-66 Gy to the sites of known disease, 54 Gy to the negative parts of the surgical bed and 50 Gy to the un-operated and clinically negative nodal regions. Radiotherapy was bilateral in 33 patients (70%) and unilateral in 14 (30%). The median interval between the surgery and the start of radiotherapy was 43 days (12-78 days).High-risk disease was defined as the presence of extracapsular extension, positive or close mucosal margins and recurrence after previous surgery.The median age was 62 years and 77% were male. The oral cavity was the most common primary site (51%) with 87% having stage III or IV disease at presentation. At the time of analysis, 18 patients had died and the 2-year LRC, progression free survival (PFS) and overall survival (OS) were 73% (95% CI, 59 to 84%), 56% (95% CI, 42 to 69%) and 62% (95% CI, 46 to 75%) respectively.Those patients who were being treated after surgery for recurrent disease had worse results than those undergoing primary treatment. When these patients were analysed separately, the 2-year LRC, PFS and OS were only 45%, 20% and 20% compared to 81%, 64% and 71% in those not being treated for recurrence. Toxicity was acceptable.The authors stated that their results were comparable with those from published randomised studies and that this is an encouraging approach in this group of patients. Results with cisplatin and carboplatin were similar but the numbers were too small to comment on the relative value of the two drugs. Reference...