TY - JOUR
T1 - Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer
T2 - The Memphis experience
AU - Robbins, K. Thomas
AU - Kumar, Parvesh
AU - Regine, William F.
AU - Wong, Frank S.H.
AU - Weir, Alva B.
AU - Flick, Pamela
AU - Kun, Larry E.
AU - Palmer, Robert
AU - Murry, Thomas
AU - Fontanesi, James
AU - Ferguson, Robert
AU - Thomas, Randall
AU - Hartsell, William
AU - Paig, Camilo U.
AU - Salazar, George
AU - Norfleet, Linda
AU - Hanchett, Catherine B.
AU - Harrington, Vanessa
AU - Niell, H. Barry
N1 - Funding Information:
Approximately 56,000 new cases of squamous cell carcinoma of the head and neck region will be diagnosed in 1995 according to the estimates of the American Cancer Society (36). The majority of patients with head and neck cancer present with advanced disease( Stage III-IV), and despite optimal treatment with surgery and/or radiation therapy. less than one-third are cured ( 12, 18, 20). Un- Reprint requeststo : K. ThomasR obbins,M .D., 956 Court Avenue,SuiteB 226. Memphis,T N 38163. Acknmvledgements-This work was supported in part by a grant controlled diseasea t local and regional sites remains the predominant cause of treatment failure. Additionally, patients often suffer the burden of organ loss and/or dysfunction and its negative impact upon quality of life. Combining systemic chemotherapy with irradiation offers preservation of organ function with the potential of improving survival outcome. However, most randomized trials comparing chemoradiation to conventional treatment have failed to demonstrate a survival advantage (7, 18 ) .
Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1997/5/1
Y1 - 1997/5/1
N2 - Purpose/Objective: To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. Methods and Materials: Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly X 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. Results: Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. Conclusion: Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.
AB - Purpose/Objective: To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. Methods and Materials: Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly X 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. Results: Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. Conclusion: Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.
KW - Concomitant radiation therapy
KW - Head and neck cancer
KW - Targeted supradose cisplatin
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U2 - 10.1016/S0360-3016(97)00092-8
DO - 10.1016/S0360-3016(97)00092-8
M3 - Article
C2 - 9226312
AN - SCOPUS:0030746369
SN - 0360-3016
VL - 38
SP - 263
EP - 271
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -