Concurrent Chemoradiotherapy for Resectable Locoregionally Advanced Squamous Cell Carcinoma of the Head and Neck-Analysis of Factors Associated with Toxicity and Efficacy

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  • 根治切除可能な進行頭頸部扁平上皮癌に対する化学放射線同時併用療法―毒性および効果に関連する因子の検討―
  • コンチ セツジョ カノウ ナ シンコウ トウケイブ ヘンペイ ジョウヒガン ニ タイスル カガク ホウシャセン ドウジ ヘイヨウ リョウホウ ドクセイ オヨビ コウカ ニ カンレン スル インシ ノ ケントウ

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Abstract

We evaluated clinical factors associated with concurrent chemoradiotherapy (CRT) toxicity and efficacy in resectable locoregionally advanced squamous cell carcinoma of the head and neck.<br>Subjects were 115 subjects with stage III or IV carcinoma undergoing 58 to 70 Gy of irradiation (median total dose: 66 Gy) concurrently with 2 cycles of chemotherapy of 5FU at 1000 mg/m2, 120-hour continuous infusion and cisplatin at 60 mg/m2.<br>Grade 3 to 4 mucositits differed significantly between 13% in N0 and 59% in N1 to 2. No significant difference in planned therapy completion was seen between 87% in N0 and 82% in N1 to 2. Three-year overall survival (OS) was 66% and progression-free survival (PFS) 55%, in median follow-up of 42 months (range: 5.8 to 91 months). OS differed significantly between 86% in stage III and 57% in IV, 78% in T0 to 2 and 62% in T3 to 4, 83% in N0 to 1 and 53% in N2, 77% in adjuvant chemotherapy (nedaplatin plus UFT) and 50% in no adjuvant chemotherapy, and 33% in the tongue and 77% in the oropharynx. PFS significantly differed between 72% in T0 to 2 and 49% in T3 to 4, 77% in CR and 53% in PR, and 22% in the tongue and 58% in the hypopharynx, 66% in the oropharynx, and 53% in the larynx. Multivariable analysis showed strongly independent risk factors associated with OS and PFS to be advanced T and N stage, no adjuvant chemotherapy, and the tongue as the site.<br>CRT was effective in treating resectable locoregionally advanced squamous cell carcinoma of the head and neck. It is possible that adjuvant chemotherapy will improve CRT OS and PFS. Other additional treatment will be needed, however, to improve OS and PFS in cases having a dismal diagnosis such as tongue cancer.

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