Chemo-Radiotherapy with Cisplatin and 5-Fluorouracil for Head and Neck Cancer

Abstract

Chemo-radiotherapy with cisplatin (CDDP) and 5-fluorouracil (5FU) employed as a first-line treatment was evaluated in fifty patients with head and neck squamous cell carcinoma from 1996 to 2001. Thirteen patients were in stage 1/II and thirty-seven patients were in stage III/IV. Forty-one patients had resectable disease and nine patients had un-resectable disease. An average of 1. 6 cycles of chemotherapy consisting of 5FU, 600 mg/m2 by continuous infusion on days 1 to 5 and CDDP, 60-70 mg/m2/day on day 4 were applied. Conventional radiotherapy with a daily dose of 2 Gy was administered concurrently and sequentially in thirty-six and three patients respectively to a total dose of 60 Gy. The remaining eleven patients, all of whom had tongue carcinoma, underwent brachytherapy (either Au-198 grain or Radium226 needle) following CDDP/5FU chemotherapy. The overall response rate to chemo-radiotherapy was 96%, with 82% complete and 14% partial response rates. With a median follow-up of 48 months, the disease specific 5-year survival and organ preservation rates were 69% and 74% for all patients, 79% and 81% for patients with concurrent chemo-radiotherapy and 62% and 57% for patients with neo-adjuvant chemo-radiotherapy respectively. Fifteen patients had loco-regional recurrences at a mean time of 7. 6 months and four patients who were loco-regionally controlled developed distant metastasis at a mean time of 18 months after chemo-radiotherapy. Even though there was no statistically significant difference, the concurrent chemo-radiotherapy tended to achieve better outcomes compared to the neo-adjuvant one in both the survival and the organ preservation rates. On the other hand, there was no difference between the concurrent and neo-adjuvant chemo-radiotherapy in the incidence of distant metastasis. For the improvement of survival rate in advanced head and neck squamous cell carcinoma, the control of distant metastasis as well as the loco-regional recurrence is indispensable and effective adjuvant chemotherapy should be introduced following first-line chemo-radiotherapy.