The addition of chemotherapy to radiation therapy doubles median survival time as well as event-free survival in patients with locally advanced head and neck cancer who have not undergone surgery, according to the results of a study published in the Lancet Oncology.
Head and neck cancers originate in the oral cavity (lip, mouth, tongue), salivary glands, paranasal sinuses, nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck. Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year. Standard treatment has included surgery and radiation, but researchers continue to evaluate the role of chemotherapy.
A study conducted in the UK, Malta, and Turkey included 966 patients with locally advanced head and neck cancer. Those who had not previously undergone surgery were randomly assigned to one of four groups:
- Radiotherapy alone (233)
- SIM (two courses of simultaneous chemotherapy and radiotherapy) (166)
- SUB (two courses of chemotherapy after completing radiation) (160)
- SIM/SUB (both simultaneous and subsequent chemotherapy) (154)
Patients who had previously undergone surgery were randomized to one of two groups: radiation alone (135) or SIM (118).
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In patients who had not undergone surgery, chemotherapy given simultaneously with radiation reduced deaths and cancer recurrence; toxicity was acceptable. Chemotherapy given after radiation did not improve survival and doubled the rate of toxicity. Patients who had undergone surgery did not benefit from chemotherapy. The results of the study are summarized in Table 1 below.
Table 1: Chemotherapy plus radiation in patients with locally advanced head and neck cancer who had not previously undergone surgery
The researchers concluded that concurrent radiation and chemotherapy improves survival and reduces recurrences, new tumors, and death in patients with locally advanced head and neck cancer who have not undergone surgery. In contrast, chemotherapy given after radiation appears to be ineffective.
 Tobias JS, Monson K, Gupta N, et al. Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial. Lancet Oncology [early online publication]. October 28, 2009.