Induction chemotherapy plus surgery and/or radiation in patients with locally advanced head and neck cancers. Retrospective analysis of 125 patients

Bulletin du Cancer. Volume 84, Number 9, 863-8, Septembre 1997, Articles originaux

Author(s) : Isabelle Ray-Coquard, Michel Bolla, Emile Reyt, Danielle Brochon, Jacques Lebeau, Marc Colonna, Hélène Kolodié, Florence Vincent, Jocelyne Chinal-Provencal.

Summary : The prognosis of locally advanced cancers of the head and the neck is pejorative, particularly when nodal involvement is present. In order to improve local control and to reduce distant failures, we have treated stages III and IV patients with induction chemotherapy. From May 1986 to November 1992, 125 patients with squamous cell carcinoma of the head and neck were treated by induction chemotherapy: cisplatine (100 mg/m2 at J1) and 5FU (1g/m2 from J1 to J5 in continuous infusion) every 21 days subsequent local therapy consisted of surgery for patients with resectable disease, and/or radiotherapy. One hundred and nineteen patients were assessable (110 men and 9 women) with a median age of 57 years (range: 36-78). All patients had performans status inferior or equal to 2. According to the TNM of UICC classification 50 patients were stage IV (42%), 61 stage III (51%), 7 stage II (6%) and a stage I (1%). One hundred (84%) patients have received at least 3 cycles of chemotherapy. Seventy-four patients (62%, IC: 60.4-63.5) had clinical objective response (complete response (CR) or partial response (PR)) with 24 patients (20%) CR and 50 patients (42%) PR. Local therapy included surgery in 81 patients (68%) and radiotherapy alone in 42 patients (35%). Overall, 103 patients (87%) were rendered clinically disease-free by treatment on this protocol. The toxicities of cisplatine and 5-FU chemotherapy consisted predominantly of myelosuppression (5%) and renal toxicities (4%) and were moderate as described for this combination. At a median follow-up of 32 months, the median survival is 38 months (CI 95%, 18-54 months), and the median time to progression is 62 months. The oropharynx localization reached statistical significance for survival rates (Log-rank test, p=0.02).

Keywords : induction chemotherapy, radiotherapy, head and neck cancer.

Pictures


		Figure 1. Survie globale de la cohorte (n = 119).


		Figure 2. Survie globale en fonction du site anatomique de la tumeur (n = 119). (----) larynx, ( ) hypopharynx, (-·-·-·-·) adénopathies cervicales isolées, (----) oropharynx, (^.........) cavité buccale. Log rank test, p = 0,01.


		Figure 3. Survie globale en fonction de la dose-intensité reçue (n = 82). (-----) Dose-intensité < 70 % de la dose-intensité théorique, (----) dose-intensité >= 70 % de la dose-intensité théorique. Log rank test, p = 0,02.