A non-randomized comparison of gemcitabine-based chemoradiation with or without induction chemotherapy for locally advanced squamous cell carcinoma of the head and neckReport as inadecuate




A non-randomized comparison of gemcitabine-based chemoradiation with or without induction chemotherapy for locally advanced squamous cell carcinoma of the head and neck - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 9:273

First Online: 06 August 2009Received: 14 June 2009Accepted: 06 August 2009DOI: 10.1186-1471-2407-9-273

Cite this article as: Specenier, P.M., Weyler, J., Van Laer, C. et al. BMC Cancer 2009 9: 273. doi:10.1186-1471-2407-9-273

Abstract

BackgroundConcomitant chemotherapy and radiotherapy chemoradiation; CRT is the standard treatment for locoregionally advanced squamous cell carcinoma of the head and neck LA-SCCHN. CRT improves local control and overall survival OS when compared to radiotherapy RT alone. Induction chemotherapy IC reduces the risk of distant metastases DM and improves OS by 5% with the use of cisplatin-infusional 5 fluorouracil PF in meta-analysis. Adding a taxane to PF in the IC regimen confers a better outcome. Sequential treatment ST of IC followed by CRT is therefore under active investigation in multiple phase III trials.

MethodsWe compared the outcome of two cohorts of patients pts with LA-SCCHN treated at our institution with CRT n = 27 or ST n = 31, respectively. CRT consisted of GEM 100 mg-m weekly + conventional RT 70 Gy; ST consisted of the same CRT preceded by platinum-based IC.

ResultsResponse to IC: complete 8 26%, partial 20 65%, stable 1, progressive 1, not evaluable 1. Median follow up of the surviving pts: for CRT 73 months, for ST 51 months. Median time to distant metastasis TDM was for CRT 23.6 months, for ST not reached. Median OS was for CRT 20.2 months, for ST 40.2 months. Cox regression analysis, taking into account age, T and N stage and tumor site, showed a hazard ratio with ST of 1.190 for time to locoregional failure p = 0.712, 0.162 for TDM p = 0.002, and 0.441 for overall survival OS p = 0.026.

ConclusionTDM and OS were found significantly longer in the ST cohort without a reduced locoregional control. Notwithstanding the limitations of a non-randomized single-center comparison, the results are in line with very preliminary data of randomized comparisons suggesting an improved outcome with ST.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-9-273 contains supplementary material, which is available to authorized users.

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Author: Pol M Specenier - Joost Weyler - Carl Van Laer - Danielle Van den Weyngaert - Jan Van den Brande - Manon T Huizing - S

Source: https://link.springer.com/







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