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Treatment results of neo-adjuvant chemotherapy in advanced head and neck cancer in Oman.

BACKGROUND AND OBJECTIVES
A prospective, single-arm study was carried out to evaluate the safety and efficacy of neo-adjuvant chemotherapy in advanced head and neck cancer (HNC) in Oman.


MATERIALS AND METHODS
The study was carried out in the Oncology and Ear, Nose and Throat (ENT) Departments, Muscat, Oman between October 1998 and December 2001. Eligible, previously untreated patients with confirmed diagnosis of locally advanced non-metastatic carcinoma of the head and neck were examined. A maximum of three cycles of neo-adjuvant chemotherapy (Cisplatin 100mg/m2 Day 1 plus 5-Fluorouracil 1gm/m2 continuous infusion for four days) were administered, followed by radical radiotherapy according to primary site. The main end-points were toxicity, response rate, disease-free survival and overall survival.


RESULTS
Seventy-three patients (45 males and 28 females) were eligible; all were evaluable for response and toxicity. The median age of studied patients was 52 years (range: 17-83 years). Forty-four patients (60%) had stage III disease and 29 (40%) had stage IV disease. After neo-adjuvant chemotherapy, Overall Response (OR) [Complete Response (CR) + Partial Response (PR)] was observed in 50 patients (68%), 33 patients (45%) had clinical CR and 17 patients (23%) had PR. Sixteen patients (22%) showed Stable Disease (SD) and 7 patients (10%) progressed while on chemotherapy. After completion of radiotherapy, the OR rate was 80%. Forty patients (55%) had clinically confirmed CR, 18 (25%) had PR, 9 patients (12%) had SD and 6 patients (8%) had progressive disease (PD). The median follow-up period was 16 months (range 3-48 months). The initial response to chemotherapy had a significant effect on survival (p= 0.011). The nasopharyngeal primary was significantly associated with high CR and longer survival (p= 0.01 and 0.02 respectively).


CONCLUSIONS
Head and neck carcinoma is not a common malignancy in Oman. The treatment results with cisplatin and 5-FU compare favorably to similar international studies and treatment-related toxicities are tolerable.