Stage III and IV Head and Neck Cancer: Does Everyone Need Chemotherapy?

Gaurav Marwaha, William L. Barrett

Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, USA.

DOI: 10.4236/ijohns.2014.31006                

Abstract

Objectives: Definitive treatment of Stage III and IV squamous cell carcinoma can be with surgical resection, definitive radiation therapy alone or combined radiation therapy with chemotherapy. Radiation and concomitant platinum-based chemotherapy are the accepted gold standard. The purpose of this study was to determine how often patients treated with radiation therapy alone developed locoregionally recurrent disease that in retrospect possibly could have been prevented with the addition of chemotherapy. Methods: 116 consecutive patients with known Stage III and Stage IV head and neck cancers were treated with curative intent with radiation therapy alone. Results of the treatment were retrospectively reviewed. Results: Of the 116 patients treated with radiation alone, 11 (9.48%) died from locally recurrent disease, 6 (5.17%) died from local disease and were never disease-free, 7 (6.03%) died from metastatic disease, 9 (7.75%) died from disease NOS, 6 (5.17%) died from secondary malignancy, 10 (8.62%) died from ICD (2 oropharynx; 8 larynx), 6 (5.17%) died from uncertain causes, 51 (43.96%) are alive and disease-free, and 10 (8.62%) patients’ final outcome data were not recoverable. Conclusions: Cure rates in selected patients with advanced head and neck cancer may be similar with radiation alone compared to radiation with the addition of chemotherapy.

Keywords

Head and Neck Cancer; Concurrent Chemoradiation; Definitive Radiation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	SEER*Stat Database: NAACCR Incidence—CiNA+. Surveillance, Epidemiology and End Results (SEER) Program. www.seer.cancer.gov.
[2]	M. D. Parkin, F. Bray, J. Ferlay, et al., “Estimating the World Cancer Burden: Globocan 2000,” International Journal of Cancer, Vol. 94, No. 2, 2001, pp. 153-156. http://dx.doi.org/10.1002/ijc.1440
[3]	J. P. Pignon, A. Maitre, E. Maillard, et al., “Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACHNC): An Update on 93 Randomised Trials and 17,346 Patients,” Radiotherapy and Oncology, Vol. 92, No. 1, 2009, pp. 4-14. http://dx.doi.org/10.1016/j.radonc.2009.04.014
[4]	D. J. Adelstein, “Concurrent Chemoradiotherapy in the Management of Squamous Cell Cancer of the Oropharynx: Current Standards and Future Directions,” International Journal of Radiation Oncology, Biology, Physics, Vol. 69, No. 2, 2007, pp. S37-S39. http://dx.doi.org/10.1016/j.ijrobp.2007.04.086
[5]	N. P. Nguyen, C. Frank, C. C. Moltz, et al., “Aspiration Rate Following Chemoradiation for Head and Neck Cancer, An Underreported Occurrence,” Radiotherapy and Oncology, Vol. 80, No. 3, 2006, pp. 302-306. http://dx.doi.org/10.1016/j.radonc.2006.07.031
[6]	A. Sanabria, A. L. Carvalho, J. G. Vartanian, et al., “Comorbidity Is a Prognostic Factor in Elderly Patients with Head and Neck Cancer,” Annals of Surgical Oncology, Vol. 14, No. 4, 2007, pp. 1449-1457. http://dx.doi.org/10.1245/s10434-006-9296-1
[7]	E. E. Vokes, R. R. Weichselbaum, S. Lippman, et al., “Head and Neck Cancer,” New England Journal of Medicine, Vol. 328, No. 3, 1993, pp. 184-194. http://dx.doi.org/10.1056/NEJM199301213280306
[8]	S. M. Lippman and W. K. Hong, “Second Malignant Tumors in Head and Neck Squamous Cell Carcinoma: The Overshadowing Threat for Patients with Early-Stage Disease,” International Journal of Radiation Oncology, Biology, Physics, Vol. 17, No. 3, 1989, pp. 691-694. http://dx.doi.org/10.1016/0360-3016(89)90126-0
[9]	A. Argiris, B. E. Brockstein, D. J. Haraf, et al., “Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy,” Clinical Cancer Research, Vol. 10, 2004, pp. 1956-1962. http://dx.doi.org/10.1158/1078-0432.CCR-03-1077