Radiation with Concurrent Late Chemotherapy (Chemoboost) for Locally Advanced Squamous Cell Carcinomas of the Head and Neck

Purpose: The aim of this study was to determine efficacy and toxicity of a treatment regimen that combined conventionally fractionated radiation therapy (70Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last two weeks of treatment, in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Thirty patients with biopsy-proven squamous cell carcinoma of the head and neck were enrolled in this study. They received a course of radiotherapy (70Gy over 7 weeks) concurrent with 360mg/m^2 of 5-fluorouracil and 10mg/m^2 of cisplatin given daily with each radiation dose during the last two weeks. Results: Nineteen patients had a complete response to chemoradiation, giving a complete response rate of 63.3%. Eleven patients had persistent disease [partial response was achieved in 8 patients (26.7%), stable disease in 2 patients (6.7%) and progressive disease in 1 patient (1.33%)]. Local control was good among the 19 patients who obtained a complete response, 15 remained free of local recurrent disease, 4 have relapsed. Locoregional relapse-free survival was 79% (15/19) at 2 years. However, considering the 11 patients with persistent disease, there was 15 patients (50%) failed at 2 years and locoregional failure-free survival was 50% (15/30). Of the 30 patients entered the study, 4 patients developed distant metastases as first relapse and 2 as subsequent failure. Therefore, an estimated 20% of the patients (6/30) developed distant metastases by 2 years either as first or subsequent failure, and distant metastases failure-free survival was 80% (24/30) at 2 years. No patients developed locoregional relapse or distant metastases during the third year. The estimated overall survival was 53.3% at 2 years and 46,7% at 3 years. Grade 3 mucositis was observed in 73.3% of patients. Acute skin reaction was severe and protracted, grade 3 developed in 50% of the patients, and the median duration of skin reaction was 5 weeks. Grade 3 and 4 neutropenia was observed in 16.6% of the patients, febrile neuropenia in 6.7% and grade 3 thrombocytopenia in 3.3%. Conclusion: The chemoboost regimen is feasible and active approach for combining chemotherapy and radiation in the management of locally advanced head and neck cancer. It is associated with significant but acceptable toxicity profile.