According to recent results presented at the 38th Annual Meeting of the American Society of Clinical Oncology, the addition of chemotherapy to radiation following surgery may improve cancer-free survival for patients with early-stage head and neck cancer, but is associated with significant side effects. Longer follow-up is needed to draw a definite conclusion.
The term head and neck cancer refers to any number of cancers that may occur in the head and/or neck region. These may include cancers of the tongue, mouth, salivary glands, pharynx, larynx, sinus and other sites located in the head and neck area. Patients with early-stage head and neck cancer have cancer that has not spread far from its site of origin. Standard treatment for early-stage head and neck cancer is surgery to remove the cancer, followed by radiation therapy. However, approximately half of these patients will experience a recurrence of their cancer, so researchers are evaluating different treatment regimens in order to improve outcomes.
Previous studies have indicated that patients with head and neck cancer who are not able to undergo surgery have decreased recurrences and improved survival when chemotherapy is added to radiation, compared to radiation alone. This prompted researchers from the Radiation Therapy Oncology Group (RTOG) to conduct a clinical trial comparing chemotherapy plus radiation therapy to radiation therapy alone following surgery for patients with head and neck cancer. This trial involved approximately 400 patients who received either radiation alone or the chemotherapy agent Platinol® (cisplatin) in addition to radiation therapy following surgery. Patients in this trial had either multiple lymph nodes that contained cancer cells or had pathology reports indicating that not all of their cancer had been removed by surgery (positive surgical margins).
At an average follow-up of approximately 27 months, cancer recurrences occurred in 26% of patients treated with radiation therapy alone, compared to 20% of patients treated with chemotherapy plus radiation. The probability of cancer-free survival at two years following therapy is 43% for patients treated with radiation therapy alone, compared to 52% for patients treated with chemotherapy plus radiation. The probability of overall survival at two years following therapy was 57% for patients treated with radiation therapy alone, compared to 63% for patients treated with chemotherapy plus radiation. In the group of patients treated with chemotherapy, 2% died from treatment-related side effects and 75% suffered severe side effects. In the group of patients treated with radiation alone, 43% suffered from severe side effects.
Although the results of this trial indicate that cancer-free survival was improved for patients treated with both chemotherapy and radiation therapy, these researchers are cautious to recommend the addition of chemotherapy to radiation following surgery for patients with early-stage head and neck cancer since side effects were dramatically increased and recurrence rates and overall survival were not significantly different between the two groups of patients. They also report that longer follow-up is necessary to determine the long-term benefits of the addition of chemotherapy following surgery in patients with early-stage head and neck cancer who have multiple cancerous lymph nodes or positive surgical margins. In addition, different chemotherapy regimens may have fewer side effects than Platinol®, while maintaining efficacy of treatment. Patients with early-stage head and neck cancer may wish to speak with their physician about the risks and benefits of chemotherapy plus radiation following surgery or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides a personalized clinical trial searches on behalf of patients.
Reference: Cooper J, Pajak T, Forastiere A, et al. Postoperative concurrent radiochemotherapy in high-risk SCCA of the head and neck: initial report of RTOG 9501/intergroup phase III trial. Proceedings from the 38th Annual Meeting of the American Society of Clinical Oncology. 2002;21:abstract 903.