RADIATION THERAPY IN THE MANAGEMENT OF HEAD-AND-NECK CANCER OF UNKNOWN PRIMARY ORIGIN: HOW DOES THE ADDITION OF CONCURRENT CHEMOTHERAPY AFFECT THE THERAPEUTIC RATIO?

被引:51
作者
Chen, Allen M. [1 ]
Farwell, D. Gregory [2 ]
Lau, Derick H. [3 ]
Li, Bao-Qing
Luu, Quang [2 ]
Donald, Paul J. [2 ]
机构
[1] Univ Calif Davis, Ctr Canc, Dept Radiat Oncol, Sch Med, Sacramento, CA 95817 USA
[2] Univ Calif Davis, Dept Otolaryngol Head & Neck Surg, Sch Med, Sacramento, CA 95817 USA
[3] Univ Calif Davis, Sch Med, Dept Med Oncol, Sacramento, CA 95817 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2011年 / 81卷 / 02期
关键词
Radiation therapy; Chemoradiation; Head-and-neck cancer; Unknown primary; Cervical lymph node metastasis; SQUAMOUS-CELL CARCINOMA; LYMPH-NODE METASTASES; LOCALLY ADVANCED HEAD; PRIMARY TUMOR; OCCULT PRIMARY; RADIOTHERAPY; CHEMORADIOTHERAPY; CHEMORADIATION; CISPLATIN; DYSPHAGIA;
D O I
10.1016/j.ijrobp.2010.06.031
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Thirty-two patients (53%) were treated by concurrent chemoradiation, and 28 patients (47%) were treated by radiation therapy alone. Forty-five patients (75%) received radiation therapy after surgical resection, and 15 patients (25%) received primary radiation therapy. Thirty-five patients (58%) were treated by intensity-modulated radiotherapy. Results: The 2-year estimates of overall survival, local-regional control, and progression-free survival were 89%, 89%, and 79%, respectively, among patients treated by chemoradiation, compared to 90%, 92%, and 83%, respectively, among patients treated by radiation therapy alone (p > 0.05, for all). Exploratory analysis failed to identify any subset of patients who benefited from the addition of concurrent chemotherapy to radiation therapy. The use of concurrent chemotherapy was associated with a significantly increased incidence of Grade 3+ acute and late toxicity (p < 0.001, for both). Conclusions: Concurrent chemoradiation is associated with significant toxicity without a clear advantage to overall survival, local-regional control, and progression-free survival in the treatment of head-and-neck cancer of unknown primary origin. Although selection bias cannot be ignored, prospective data are needed to further address this question. (C) 2011 Elsevier Inc.
引用
收藏
页码:346 / 352
页数:7
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