Radiosensitization of Cis-Platinum in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma

Chang, Hyesook

Abstract

Cis-Platinum (DDP) was utilized as a radiosensitizer in a pilot study for stage III and IV squamous cell carcinoma between 1984-1987, and DDP 20 mg/M2/day was administered for 4 days at 3 week interval with concurrent radiotherapy. This study consisted of three phases: cytoreduction phase, eradicative treatment phase and adjuvant phase. Total 59 patients were subjected to evaluate a tumor response and its toxicity. During the eradicative phase,27 patients underwent surgery(group I), 29 patients were treated with radiotherapy only(groupII) and 3 patients did not complete the second phase of therapy. At the cytoreduction phase, 95% response rate with complete response (CR) 47.5% and partial response (PR) 47.5%, was observed. Complete tumor clearance (CTC) rate following 2nd phase of therapy was 84% (47/56) with 26/27 (96%) in groupI achieved CTC with surgery and 21/29 (72%) patients in group II achieved CTC following 2nd phase. 67% of primary lesions and 70% of nodal diseases in group I showed no tumor in the surgical specimen. 34% of patients who achieved CTC at 2nd phase developed recurrence and median time to recur was 8 months. Actuarial disease free survival at 4 years was 59% and 51% (24/27) of patients who achieved CTC at End phase were alive without any evidence of disease at Median follow-up 31 months (range, 10-48 months). There was no significant difference in overall and disease free survival between groupI and II, between CR and PR group following 1st phase. Only significant prognostic factor in this study was the complete tumor clearance following 2nd phase therapy. In general, toxicity was not excessive. Author concludes that this study confirmed the significant radiosensitizing effect of DDP with the acceptable toxicity and warrant the prospective study to determine optimum scheduling for DDP and radiotherapy which maximizes the therapeutic gain.