PRIMARY CONCURRENT CHEMOTHERAPY AND RADIATION IN HEAD AND NECK SQUAMOUS CELL CARCINOMA

Primary treatment with concurrent chemotherapy and radiation:
- Has been accepted widely as a standard of care:
  - Since the publication of the Meta-Analysis of Chemotherapy on Head and Neck Cancer in 2000
- This meta-analysis was later updated in 2009:
  - Involving an analysis of 50 trials that showed an absolute survival benefit of 6.5% at 5 years:
    - Associated with administering chemotherapy concurrently with radiation
Bolus cisplatin (100 mg/m2 on days 1, 22, and 43) concurrent with radiation therapy:
- Has been extensively studied and may be considered the standard to which other chemotherapy regimens are compared in clinical research
The intergroup trial conducted by Adelstein and colleagues was influential in establishing this regimen as a standard of care (Figure):
- In a three-arm randomized phase III trial of 295 patients:
  - With locally advanced stage M0 head and neck squamous cell carcinoma (SCC):
    - The treatment groups were:
      - Radiation therapy alone (70 Gy) versus
      - Identical radiation plus concurrent cisplatin (100 mg/ m2 administered intravenously on days 1, 22, and 43) versus a split course of radiation with cisplatin plus 5-FU
  - With a median follow up of 41 months:
    - The concurrent cisplatin / radiation arm had a significant advantage in survival at 3 years compared with radiation alone:
      - 37% versus 23%, p = .014
    - Survival in the split-course concurrent arm (27%):
      - Was not significantly better than that in the radiation arm
    - This improved efficacy comes at the cost of an increased incidence of acute toxicities:
      - Including mucositis and nausea / vomiting
    - Four toxic deaths occurred among 95 patients enrolled in the cisplatin chemoradiation arm