Addition of Cisplatin to Radiation Improves Survival in Head and Neck Cancer
According to results from two clinical trials published in The New England Journal of Medicine, the addition of the chemotherapy agent cisplatin (Platinol®) to radiation improves survival compared to radiation therapy alone in the treatment of locally advanced head and neck cancer.
Approximately 40,000 people in the United States are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancer, including the nasal cavity and sinuses, oral cavity, nasopharynx, oropharynx, and other sites located in the head and neck area. Locally advanced head and neck cancer refers to cancer that has spread locally from its site of origin to surrounding tissues, but not to distant sites in the body. Standard treatment for locally advanced head and neck cancer often consists of chemotherapy and radiation therapy and possible surgery. Researchers continue to evaluate and compare different treatment regimens or novel therapeutic approaches to improve survival and quality of life in patients with head and neck cancer.
In the first reported trial, researchers from the European Organization for Research and Treatment of Cancer Trial 22931 conducted a clinical trial to directly compare radiation alone to cisplatin plus radiation following surgery for the treatment of advanced head and neck cancer. This trial included 167 patients who were all initially treated with surgery. Approximately half of the patients then received radiation alone and the other half received radiation plus cisplatin. After an average of approximately 5 years, progression-free survival was 47% in the group of patients treated with cisplatin plus radiation, and only 36% in the group of patients treated with radiation only. The overall survival rates at 5 years were 53% for patients treated with cisplatin and radiation therapy, compared with only 40% for patients treated with radiation only. Severe side effects occurred in 41% of patients treated with combination therapy, compared with only 21% of patients treated with radiation alone.1
In the second reported trial, researchers from the Radiation Therapy Oncology Group 9501/Intergroup also directly compared radiation therapy to radiation plus chemotherapy in the treatment of head and neck cancer. This trial included 459 patients, all of whom had their cancer surgically removed, but were considered to be at a high risk of developing a cancer recurrence. Following surgery, patients were treated with either radiation alone or radiation plus chemotherapy including cisplatin. After nearly 4 years (approximately 46 months), cancer-free survival was improved by 22% in the patients treated with radiation and chemotherapy, compared to those treated with radiation alone. However, overall survival was similar. Cancer recurrences at or near the site of origin of cancer occurred in 18% of patients treated with combined therapy, compared to 28% of patients treated with radiation alone at approximately 2 years following treatment. Severe side effects occurred in 34% of patients treated with radiation alone, compared with 77% of patients treated with chemotherapy and radiation therapy.2
The researchers from both of these trials concluded that the addition of chemotherapy to radiation therapy is superior to radiation therapy alone following surgery in the treatment of head and neck cancer. Future clinical trial evaluating agents that are not associated with such a high rate of side effects and/or combination chemotherapy are warranted. Patients diagnosed with head and neck cancer that may be removed by surgery should speak with their physician about the risks and benefits of combination therapy or the participation in a clinical trial evaluating newer therapeutic agents. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( cancer.gov).
1.Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. The New England Journal of Medicine. 2004; 350:1945-1952.
2.Cooper J, Pajak T, Forastiere A, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. The New England Journal of Medicine. 2004;350:1937-1944.