Neoadjuvant Chemotherapy Can Improve Head And Neck Cancer Survival

By Megan Rauscher

NEW YORK NOV 19, 2004 (Reuters Health) - Five- and 10-year follow-up data from a randomized phase III trial support the use of induction chemotherapy before radiotherapy for patients with inoperable advanced head and neck squamous cell carcinoma (HNSCC) according to Italian researchers.

"Our study," investigator Dr. Adriano Paccagnella from the SS Giovanni and Paolo Hospital in Venice told Reuters Health, "was one of the first trials to show a survival benefit by adding chemotherapy to radiotherapy alone in patients with inoperable head and neck cancer."

The Italian trial, launched in 1986, compared four cycles of neoadjuvant chemotherapy with cisplatin and 5-FU followed by locoregional treatment (surgery and radiotherapy or radiotherapy alone) with definitive locoregional therapy alone in 237 patients with nonmetastatic stage III and IV HNSCC.

In the November 17th in the Journal of the National Cancer Institute, the team reports that
 induction chemotherapy did not improve overall survival at 5 and 10 years.  The 5-year survival rate was 23% with induction chemotherapy versus 16% without it.  The 10-year survival rates  were 19% and 9%.

However, in subgroup analyses, patients with inoperable HNSCC who received induction chemotherapy had significantly higher survival at 5 and 10 years compared with those that did not receive induction chemotherapy.  The 5-year survival rate was 21% with induction chemotherapy versus 8% without it. The 10-year survival rate was 16% with versus 6% without induction chemotherapy. 

There were no marked differences in survival with or without induction chemotherapy in patients with operable tumors.

In an accompanying editorial, Dr. Arlene A. Forastiere, from the Johns Hopkins Kimmel Cancer Center in Baltimore observes that the results "support testing the addition of induction chemotherapy to chemoradiotherapy among patients with unresectable disease."  Two such studies, she adds, are set to begin shortly.

SOURCE:

• Journal of the National Cancer Institute 2004;96:1647-1649,1714-1717.