Final results of a phase II single-institutional trial with hyperfractionated radiation therapy (HFX) and four-weekly continuous cisplatin in locally advanced head and neck carcinoma

• Autores: Fernando Arias de la Vega, Gemma Asín Felipe, María Uzcanga Lacabe, E. Maraví, I. Quílez Sardá, V. Chicata, Clara Eíto Valdovinos, A. Viudez, I. Hernández, F. Mañeru, Miguel Angel Domínguez Domínguez
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 16, Nº. 6, 2014, págs. 555-560
• Idioma: inglés
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• Resumen

  • Background To evaluate the efficacy and toxicity of hyperfractionated radiation therapy and continuous infusion of cisplatin on weeks 1 and 5 in locally advanced head and neck carcinoma.

    Methods There were 53 patients: 3 (5.7 %) T2 patients, 31 T3 patients (58.4 %), and 19 T4 patients (35.8 %). Forty-one patients (77.4 %) were N-positive. According to the AJCC, 40 (75.4 %) patients had stage IV and the rest stage III. Treatment consisted of hyperfractionated radiation therapy, 120 cGy bid to a dose of 76.8�81.6 Gy, and cisplatin 20 mg/m2/day administered by continuous infusion over 120 h during days 1�5 and 21�25 of radiation therapy.

    Results Tumor response and toxicity There were 40 (75.5 %) complete responses, 6 partial responses (11.3 %), and 5 (9.4 %) non-responses or progression. Two patients were non-evaluable for response due to toxic death. All patients had some acute toxicity grade, the most frequent being mucositis (grade 3�4 in 33 patients) and epithelitis (grade 3�4 in 30 patients). Regarding late toxicity, only 2/24 long-term survivors had tracheostomy, and none of them needed enteral nutrition. Survival and local control With a median follow-up of 66 months, the 5-year overall survival rate for all the series was 49.1 % (95 % CI 58.9�39.3 %) with a median survival duration of 32.83 months. Five-year local control was 68.4 % (95 % CI 81.3�55.5 %).

    Conclusions Hyperfractionated radiation therapy and continuous infusion of cisplatin during weeks 1 and 5 are an active treatment in patients with LAHNC. Nevertheless, new strategies are necessary to increase the local control rates and reduce the incidence of distant metastasis and second tumors.