Preoperative Chemotherapy-Sensitized Radiation Therapy for Cervical Metastases in Head and Neck Cancer

Matthew M. Puc, Francis A. Chrzanowski, Hoang S. Tran, Li Liu, Arvin S. Glicksman, Christine Landman, Gus J. Slotman
2000 Archives of Otolaryngology - Head and Neck Surgery  
Objective: To determine the efficacy of concurrent preoperative cisplatin chemotherapy and radiotherapy (CT/ RT) for patients with advanced head and neck cancer and cervical metastatic disease. Design: Retrospective analysis. Setting: University hospitals. Patients: Eighty-eight patients with operable stage III and IV squamous cell carcinoma of the head and neck and palpable cervical lymphogenous metastases received preoperative concurrent CT/RT followed by planned neck dissection.
more » ... : All patients undergoing CT/RT received concomitant continuous infusions of cisplatin (20 mg/m 2 ) on days 1 to 4 and 22 to 25 of CT/RT. Thirty-nine patients underwent single-fraction (1.8-Gy) radiotherapy to 45.0 Gy, and 49 patients received 10 single-fraction (1.8-Gy) treatments, which were hyperfractionated (1.2-Gy twice a day) to 46.8 Gy. Main Outcome Measures: The 71 patients for whom complete post-CT/RT data were available were evaluated for clinical response in addition to survival. Histologic complete response (HCR) was confirmed from planned neck dissection specimens (n = 48) after clini-cal complete response (CCR) from initial CT/RT. Kaplan-Meier statistical analysis for disease-specific survival and overall survival was performed on all 88 patients who received CT/RT. Results: A CCR and an HCR were noted in 78% (18/ 23) and 59% (10/17) of patients with N1 lesions, respectively, and in 60% (29/48) and 45% (14/31) of patients with N2-3 lesions, respectively. The percentage of patients with CCR who also had HCR was 67% (10/15) for patients with N1 lesions and 54% (14/26) for patients with N2-3 lesions. With a median follow-up of 18.5 months, the Kaplan-Meier disease-specific survival rate at 54 months (n = 88) was 70% (21/30) for patients with N1 lesions, 60% (24/40) for patients with N2 lesions, and 39% (7/18) for patients with N3 lesions. The overall survival and disease-specific survival rates at 5 years for all nodal groups combined were 36% (32/88) and 59% (52/88), respectively. Conclusions: A CCR to CT/RT was achieved in nearly two thirds of patients with head and neck cervical lymphogenous metastases, independent of nodal tumor load. Most patients (59% [24/41]) with CCR were pathologically tumor free before neck dissection.
doi:10.1001/archotol.126.3.337 pmid:10722006 fatcat:zq2nk7qhb5errlioxbppjtncj4