Five-Year Update of a Randomized Trial of Alternating Radiotherapy and Chemotherapy Compared With Radiotherapy Alone in Treatment of Unresectable Squamous Cell Carcinoma of the Head and Neck

• Published in: JNCI : Journal of the National Cancer Institute Vol. 88; no. 9; pp. 583 - 589
• Main Authors: Merlano, Marco, Benasso, Marco, Corvò, Renzo, Rosso, Riccardo, Vitale, Vito, Blengio, Fulvia, Numico, Gianmauro, Margarino, Giovanni, Bonelli, Luigina, Santi, Leonardo
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01-05-1996; Superintendent of Documents
• Subjects: Antimetabolites, Antineoplastic - administration & dosage; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - secondary; Chemotherapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Drug Administration Schedule; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Head; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Male; Medical research; Medical sciences; Middle Aged; Neck; Neoplasm Staging; Pharmacology. Drug treatments; Radiation; Radiotherapy Dosage; Radiotherapy, Adjuvant; Survival Analysis; Treatment Outcome; Antineoplastic agent; Human; Alternance; Drug combination; Squamous cell carcinoma; Toxicity; Malignant tumor; Radiotherapy; Result; Chemotherapy; Head and neck; ENT disease; Pyrimidine derivatives; Combined treatment; Fluorine Organic compounds; Comparative study; Platinum II Complexes
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/88.9.583

Background: In 1992, we reported the first analysis of a randomized trial comparing alternating radiotherapy and chemotherapy with radiotherapy alone in the treatment of squamous cell carcinoma of the head and neck. The results of that 3-year analysis indicated that the combined treatment had superior efficacy. Purpose: After an additional 2 years of follow-up, we again compared the efficacy of the two treatment regimens, with attention paid to differences in overall survival, progression-free survival, and locoregional relapse-free survival. Methods: One hundred fifty-seven patients with untreated, unresectable squamous cell carcinoma of the head and neck were randomly assigned to receive either chemotherapy (four courses of cisplatin [20 mg/m2] and fluorouracil [200 mg/m2], given daily for 5 consecutive days during weeks 1, 4, 7, and 10) plus radiotherapy (three courses of 20 Gy each, given in fractions of 2 Gy per day during weeks 2–3, 5–6, and 8–9) or radiotherapy alone (70 Gy total dose, given in fractions of 2 Gy per day, 5 days per week). Eighty patients received the combined therapy, and 77 were treated with radiotherapy alone. Responses, failures, and toxic effects associated with the two treatment regimens were compared. Overall survival, progression-free survival, and locoregional relapse-free survival were calculated according to the Kaplan-Meier method; the logrank test was used to compare survival parameters between the two patient groups. Reported P values are two-sided. Results: As reported previously, toxic effects associated with the combined therapy included both chemotherapy- and radiotherapy-related effects; however, the incidence and severity of mucositis were nearly identical among patients in the two treatment arms. The combined treatment was associated with a statistically significant increase in the frequency of complete response (i.e., the disappearance of clinically detectable disease for at least 4 weeks) (43% for the combined-treatment group compared with 22% for the radiotherapy-only group; P =.037, chi-squared test). Five-year estimates of overall survival in the combined-treatment group compared with the radiotherapy-only group were 24% (95% confidence interval [CI] = 14%–40%) and 10% (95% CI = 4%–24%), respectively (P =.01, logrank test). The estimates of progression-free survival at 5 years in the combined-treatment group compared with the radiotherapy-only group were 21% (95% CI = 11%–37%) and 9% (95% CI = 3%–22%), respectively (P =.008, logrank test). Finally, the 5-year estimates of locoregional relapse-free survival were 64% (95% CI = 36%–84%) in the combined-treatment group and 32% (95% CI = 10%–65%) in the radiotherapy-only group (P =.038, logrank test). Conclusions and Implications: The superiority of alternating chemotherapy and radiotherapy over radiotherapy alone in treating unresectable squamous cell carcinoma of the head and neck seen at 3 years was confirmed at 5 years. However, additional trials must be conducted before considering the combined approach as standard therapy. [J Natl Cancer Inst 1996; 88: 583–9]