Locally advanced head/neck cancer

Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/ neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving CRT are not well established. This study was performed to elucidate selected outcomes in a patient population. A retrospective study of LA-HNC patients >70 years of age who had received 5-fluorouracil-hydroxyurea (HU)-based CRT with a minimum of 3 years of follow-up after therapy initiation was performed [10 ]. Pretreatment patient- and cancer-related characteristics were recorded, and survival data in addition to gastrostomy tube utilisation, swallowing function, and haematologic toxicity were captured [lO j. 

Maggiore RJ, Curran EK, Witt ME, Haraf DJ, Yokes EE, Cohen EEW. Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemo radiation therapy. J Ger Oncol 2013 4(4) 327-33. 

The regimes combining Orzel and capecitabine with radiation therapy have become the focus of increasing interest in the management of patients various malignancies including rectal, anal, locally advanced head and neck, esophageal, and pancreatic cancers. 

Brizel DM, Alberx MF, Fisher SR, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998 338 1798-1804. 

Sunwoo JB, Herscher LL, Kroog GS, et al. Concurrent paclitaxel and radiation in the treatment of locally advanced head and neck cancer. J Clin Oncol 2001 19(3) 800-811. 

Koukourakis MI, Bizakis JG, Skoulakis CE, et al. Combined irinotecan, docetaxel and conventionally fractionated radiotherapy in locally advanced head and neck cancer. A phase I dose escalation study. Anticancer Res 1999 19(3B) 2305-2309. 

Eisbruch A, Shewach DS, Bradford CR, et al. Radiation Concurrent With Gemcitabine for Locally Advanced Head and Neck Cancer A Phase I Trial and Intracellular Drag Incorporation Study. J Clin Oncol 2001 19 792-799. 

Browman GP, Cripps C, Hodson DI. Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer, Author Update. Classic Papers and Current Comments 1999 4 625-630. 

Posner MR, Glisson B, FrenetteG, etal. Multicenter phase I-II trial of docetaxel, cisplatin, and fluorouracil induction chemotherapy for patients with locally advanced squamous cell cancer of the head and neck. J Clin Oncol 2001 19 1096-1104. 

Laskar SG, Agarwal JP, Srinivas C, Dinshaw KA. Radiotherapeutic management of locally advanced head and neck cancer. Expert Rev Anticancer Ther. 2006 6 405M17. 

Fety R, Rolland F, Barberi-Heyob M, Hardouin A, Campicm L, Conroy T, Merlin J-L, Riviere A, Perrocheau G, Etienne MC, Milano G. Clinical impact of i iarmacokineticallyguided dose adaptation of 5-fluorouracil results from a multicentric randomized trial in patients with locally advanced head and neck carcinomas. Clin Cancer Res (1998) 4,2039-45. 

Budach V, Stuschke M, Budach W, et al (2005) Hyperfraction-ated accelerated chemoradiation with concurrent fluo-rouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol 23 1125-1135... 

Awwad HK, Khafagy Y, Barsoum M, et al (1992) Accelerated versus conventional fractionation in the postoperative irradiation of locally advanced head and neck cancer influence of tumour proliferation. Radiother Oncol 25 261-266... 

Awwad HK, Lotayef M, Shouman T, et al (2002) Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer influence of proliferation. BrJ Cancer 86 517-523... 

Gonzalez-Larriba J, Garcia Carbonero I, Sastre Valera J, Perez Segura P, Diaz-Rubino E. Neoadjuvant therapy with cisplatin/fluorouracil vs cisplatin/UFT in locally advanced squamous cell head and neck cancer. Oncology (Huntingtj 1997 11(9 Suppl 10) 90-97. 

Early clinical studies clearly demonstrated that cisplatin could be administered safely and concurrently with radiation therapy (73-75). Early clinical trials that demonstrated the promise of the combination of cisplatin and radiation therapy included the treatment of brain tumors (76,77), head and neck tumors (78), malignant melanoma (79), and bladder cancer (80). Early clinical trial integrating carboplatin administration with radiation therapy was carried out in patients with locally advanced nonsmall cell lung cancer (NSCLC) (81). A hypothesis put forth by Coughlin and colleagues (81) was that the best clinical outcomes would be achieved with the combination of cisplatin and radiation therapy in tumors that were responsive to cisplatin. 

Haselow RE, Adams GS, Oken MM, Goudsmit A, Lemer HJ, Marsh JC. Simultaneous cis-platinum (DDP) and radiation therapy (RT) for locally advanced unressectable head and neck cancer. Int J Radiat Oncol Biol Phys 1982 8 201. 

Dowell JE, Sinard R, Yardley DA, et al. Seven-week continuous-infusion paclitaxel concurrent with radiation therapy for locally advanced non-small cell lung and head and neck cancers. Semin Radiat Oncol 1999 9(2 Suppl 1) 97-101. 

Suntharalingam M, Haas ML, Van Echo DA, et al. Predictors of response and survival after concurrent chemotherapy and radiation for locally advanced squamous cell carcinomas of the head and neck. Cancer 2001 91(3) 548-554. 

Kies ME, Haraf D, Rosen F, Stenson K, List M, Brockstein B, Chung T, Mittal B, Pelzer H, Portugal L, Rademaker A, Weichselbaum R, Vokes EE. Concomitant Infusional Paclitaxel and Fluorouracil, Oral Hydroxyurea, and Hyperfractionated Radiation for Locally Advanced Squamous Head and Neck Cancer. J Clin Oncol 2001 19 1961-1969. 

A preliminary report on a randomized trial on 83 stage III or IV locally advanced squamous cell head and neck cancer (SCHNC) patients demonstrated improved 2-yr disease-free survival (65% vs 41%, p = 0.01) and increased rate of local control (85% vs 59%, p < 0.05) in the concomitant chemoradiation group (cisplatin 50 mg/m2 weekly) in comparison to radiation therapy alone (25). It should be noted that the DFS was improved overall in the concomitant arm despite 18% patients receiving only two-thirds of their scheduled dose of cisplatin as a result of nausea and vomiting. Mature results from this study have not been published to date. 

Cetuximab is indicated for the treatment of head, neck and colorectal cancers, and in combination with radiation therapy it is used for the treatment of squamous cell carcinoma (locally or regionally advanced) of the head and neck. However, in patients with recurrent or metastatic squamous cell carcinoma of the head and neck whose response to the previous platinum-based therapy has not been positive, it is not given in combination with radiation therapy and is administered alone. Generally, a dose of 400 mg/m2 is initially administered in combination with radiation therapy followed by a maintenance dose of 250 mg/m2 and is administered 1 h... 

Cisplatin, in combination with bleomycin, etoposide, ifosfamide, or vinblastine, cures 90% of patients with testicular cancer. Used with paclitaxel, cisplatin induces complete response in most patients with carcinoma of the ovary. Cisplatin produces responses in cancers of the bladder, head and neck, cervix, and endometrium all forms of carcinoma of the lung anal and rectal carcinomas and neoplasms of childhood. The drug sensitizes cells to radiation therapy and enhances control of locally advanced lung, esophageal, and head and neck tumors when given with irradiation. 

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