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Concurrent chemoradiation therapy for advanced head and neck squamous cell carcinoma (HNSCC) in a community hospital.

5558 Background: Concurrent chemotherapy and radiation therapy have made organ preservation feasible in patients with advanced head and neck squamous cell carcinoma. This study evaluates the use of chemotherapy with hyperfractionated radiation therapy in a community hospital and the importance of elective lymph node dissection for N2 and N3 patients.


METHODS
Forty-six patients with HNSCC stage III and IV (42/46 male, 35/46 oropharynx, 4 hypopharynx, 7 larynx, 25 N0-1, 21 N2-3) were treated. Median follow-up is 18.7 months (1-46 months). Hyperfractionated radiation therapy was administered twice daily with an interval of at least six hours and a total dose of 7000cGy to the primary site and 5-6000cGy to the adjacent lymph node bearing areas. Chemotherapy was administered during weeks 1 and 6 of radiation therapy and consisted of cis-platin 12mg/M2 IVPB days 1-5 and 5-fluorouracil 600mg/M2 continuous IV infusion over 20 hours days 1-5. Twenty of twenty-one patients with N2-3 disease underwent neck dissection 6-8 weeks following completion of XRT. All pts had insertion of indwelling venous access devices and percutaneous endoscopic gastrostomy tubes.


RESULTS
Complete response (CR) at the primary site following chemo-XRT occurred in 45/46 (98%). All pts with N1 achieved CR. 20 of 21 N2-3 underwent neck dissection. Fourteen were downstaged to N0 and six to N1. Two pts died in remission from intercurrent illnesses more than 11 months after completion of therapy. Of the remaining 44 pts, 38 remain NED (86%) (3 pts died from recurrent disease, 2 pts recurred locally and were salvaged surgically, one is alive with metastatic disease).


TOXICITY
short term, all pts developed confluent mucositis but hospitalization for dehydration or infection was rare; long term, mouth dryness was common but manageable and most pts were PEG independent within three months of completion of therapy.


CONCLUSIONS
Aggressive chemo-XRT is feasible in a community hospital and affords advanced HNSCC pts the opportunity for organ preservation. Pts with N2 or N3 disease should undergo neck dissection following chemo-XRT since thirty percent of these pts will have node metastases. No significant financial relationships to disclose.