Chemotherapy plus Radiation Therapy Superior to Aggressive in Some cancer
According to a recent article published in the *International Journal of Radiation Oncology, Biology, Physics,*the treatment combination of chemotherapy plus radiation therapy results in improved outcomes compared to aggressive radiation therapy for cancers of the oropharynx or hypopharynx that cannot be surgically removed.
Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would die from head and neck cancer.
The oropharynx is the part of the throat that lies behind the mouth. The hypopharynx is the bottom part of the throat that leads to the esophagus (tube leading to the stomach) and the larynx (tube where air passes to the lungs).
Standard treatment for cancer of the oropharynx or hypopharynx is largely determined by the stage (extent to which the cancer has spread) as well as the specific locations to which the cancer has spread. The patient’s overall medical condition is also a consideration. Treatment typically consists of radiation therapy, chemotherapy with surgery, or surgery alone.
Unfortunately, a significant portion of patients are not able to undergo surgery; this condition is referred to as “unresectable”. Cancer is typically considered unresectable due to the extent of spread of the cancer, the structures to which the cancer has spread, or the patient’s medical condition.
Treatment for unresectable head and neck cancers tends to be associated with significant side effects and a greatly reduced quality of life. As a result, research continues to evaluate different radiation treatment schedules and/or chemotherapy agents that will produce optimal outcomes while maintaining quality of life for these patients.
Researchers from France recently conducted a phase III clinical trial to directly compare two different treatment options in patients with unresectable cancers of the oropharynx or hypopharynx. This trial included 163 patients who were treated with either chemotherapy, consisting of Platinol® (cisplatin) and 5-flurouracil (5-FU) plus standard radiation therapy, or aggressive radiation therapy.
Patients treated with chemotherapy/radiation therapy had improved outcomes:
- At 2 years, overall survival was 38% for patients treated with chemotherapy/radiation therapy, compared with 20% for those treated with aggressive radiation therapy.
- At 2 years, cancer-free survival was 48% for patients treated with chemotherapy/radiation therapy, compared with 25% for those treated with aggressive radiation therapy.
- Severe mucositis (inflammation or ulceration of the lining of the mouth or throat) and low levels of immune cells were significantly higher for those treated with chemotherapy plus radiation therapy compared to those treated with aggressive radiation therapy.
- At 1 and 2 years following treatment, no significant difference in the amount of side effects was noted between the two groups of patients.
The researchers concluded that chemotherapy plus radiation therapy appears superior to aggressive radiation therapy in the treatment of unresectable cancers of the hypopharynx or oropharynx. However, it is important for patients with unresectable head and neck cancer to speak with their physician regarding their individual risks and benefits of various treatment options.
Reference: Bensadoun R-J, Benezery K, Dassonville O, et al. French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: Results at 2 years (FNCLCC-GORTEC). International Journal of Radiation Oncology, Biology, Physics. 2006; 64: 983-994.
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