Efficacy and toxicity of chemoradiotherapy using intensity-modulated radiotherapy for unknown primary of head and neck.

Abstract

PURPOSE:

No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP.

PATIENTS AND MATERIALS:

A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity.

RESULTS:

A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture.

CONCLUSION:

In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.

• Authors: David J Sher, Tracy A Balboni, Robert I Haddad, Charles M Norris Jr, Marshall R Posner, Lori J Wirth, Laura A Goguen, Donald Annino, Roy B Tishler
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 80 Issue 5 Pg. 1405-11 (Aug 01 2011) ISSN: 1879-355X [Electronic] United States
• PMID: 21177045 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Aged
• Boston
• Cancer Care Facilities
• Carcinoma, Squamous Cell (drug therapy, mortality, pathology, radiotherapy)
• Combined Modality Therapy (adverse effects, methods)
• Esophageal Stenosis (etiology)
• Female
• Head and Neck Neoplasms (drug therapy, mortality, pathology, radiotherapy)
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Neoplasms, Unknown Primary (drug therapy, mortality, pathology, radiotherapy)
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated (adverse effects)
• Retrospective Studies
• Xerostomia (etiology)