A phase II trial of induction chemotherapy and chemo-IMRT for head and neck squamous cell cancers at risk of bilateral nodal spread: the application of a bilateral superficial lobe parotid-sparing IMRT technique and treatment outcomes.

Abstract

PURPOSE:

To determine the feasibility of induction chemotherapy and chemo-IMRT in head and neck squamous cell cancers at risk of bilateral nodal spread (midline tumours) and to evaluate whether bilateral superficial lobe parotid-sparing IMRT can reduce the incidence of ⩾G2 subjective xerostomia.

METHODS:

Patients with midline tumours were enrolled to a phase II trial to receive induction platinum/5-fluorouracil and concomitant platinum with combined superficial lobe parotid-sparing IMRT. The primary site and involved nodal levels received 65 Gy in 30 fractions (f) and at risk nodal levels, 54 Gy/30f. Incidence of ⩾G2 subjective xerostomia was defined as the primary endpoint. Secondary endpoints included incidences of acute and late toxicities and survival outcomes dependent on human papilloma virus (HPV) status.

RESULTS:

One hundred and twenty patients with midline cancers completed treatment between December 2005 and May 2010 with median follow-up of 50 months. Incidences of ⩾G2 acute toxicities were: dysphagia 75%; xerostomia 65%; mucositis 86%; pain 83%; and fatigue 64%. At 12 months, ⩾G2 subjective xerostomia was observed in 21% (17% in HPV +ve). Two-year loco-regional progression-free survival (PFS) was 90.7% (95% CI: 85.2-96.2). According to HPV status, there was a significant difference for 2-year loco-regional PFS, 76.8% (HPV-negative) vs 98.6% (HPV-positive), P=0.001. 2-year overall survival was 93% for HPV-positive compared with 52% for HPV-negative cases, P<0.001.

CONCLUSIONS:

Sequential chemotherapy/chemo-IMRT for midline tumours is feasible, with excellent survival outcomes. At 1 year, 21% experience ⩾G2 subjective xerostomia. Two-year survival outcomes differ significantly between HPV-positive and HPV-negative disease, suggesting development of different treatment schedules for the different disease entities.

• Authors: A B Miah, U Schick, S A Bhide, M-T Guerrero-Urbano, C H Clark, A M Bidmead, S Bodla, L Del Rosario, K Thway, P Wilson, K L Newbold, K J Harrington, C M Nutting
• Journal: British journal of cancer (Br J Cancer) Vol. 112 Issue 1 Pg. 32-8 (Jan 06 2015) ISSN: 1532-1827 [Electronic] England
• PMID: 25474250 (Publication Type: Clinical Trial, Phase II, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Squamous Cell (drug therapy, radiotherapy)
• Child
• Child, Preschool
• Disease-Free Survival
• Female
• Head and Neck Neoplasms (drug therapy, radiotherapy)
• Humans
• Induction Chemotherapy
• Male
• Middle Aged
• Parotid Gland (diagnostic imaging, radiation effects)
• Prospective Studies
• Radiation Injuries (etiology, prevention & control)
• Squamous Cell Carcinoma of Head and Neck
• Treatment Outcome
• Ultrasonography
• Xerostomia (etiology)
• Young Adult