Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic

Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):923-9. doi: 10.1016/j.ijrobp.2010.07.013. Epub 2010 Nov 20.

Abstract

Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer.

Methods and materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients.

Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients.

Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Chemoradiotherapy / adverse effects*
  • Chemoradiotherapy / methods
  • Chemoradiotherapy / mortality
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects*
  • Creatinine / blood
  • Deglutition
  • Deglutition Disorders / etiology*
  • Disease-Free Survival
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / blood
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration
  • Radiotherapy, Conformal / adverse effects
  • Radiotherapy, Conformal / methods
  • Retrospective Studies
  • Survival Rate
  • Young Adult

Substances

  • Antineoplastic Agents
  • Creatinine
  • Cisplatin