Preferred Concurrent Agent with Definitive Radiation Theray (RT) for Unresected Stage III–IVB Head and Neck Squamous Cell Carcinoma (HNSCC)?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Preferred concurrent agent with definitive RT in unresected stage III–IVB HNSCC:
    • Cisplatin 100 mg / m² q3 weeks
  • Why it’s right: 
    • Decades of level-1 evidence show concomitant cisplatin-RT improves:
      • OS vs RT alone (MACH-NC)
    • The q3-weekly 100 mg / m² schedule is the historical standard in definitive settings:
      • Used in the pivotal organ-preservation and superiority trials that shaped practice
  • When to deviate: 
    • True cisplatin-ineligible:
      • CrCl < 50, grade ≥ 2 hearing loss / neuropathy):
        • Consider cetuximab-RT or carboplatin-based radiosensitization
  • Pitfalls: 
    • Choosing cetuximab to “reduce toxicity” in HPV+ disease:
      • Worse survival vs cisplatin in RTOG-1016 / De-ESCALaTE trials.
  • Numbers to quote: 
    • MACH-NC:
      • CRT vs RT:
        • HR death ~ 0.83; + 6% to 7% 5-yr OS
  • MACH-NC (Radiother Oncol 2021, IPD meta-analysis)
  • Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group
    • What it asked: 
      • Does adding chemo to RT improve outcomes in non-metastatic HNSCC?
    • Design: 
      • Updated individual-patient meta-analysis of 107 RCTs (n≈19,800)
    • Key results: 
      • Concurrent chemoradiation (CRT) improved OS vs RT alone:
        • HR 0.83:
          • Giving an absolute + 6.5% OS at 5 yrs and + 3.6% at 10 yrs
      • Concurrent chemoradiation (CRT) improved event-free survival:
        • HR 0.80:
          • + 5.8% at 5 yrs
      • Benefit mainly from less locoregional failure (sub-HR ~0.71)
      • No clear distant-failure reduction
      • Induction or adjuvant chemotherapy did not improve OS overall
      • Benefit attenuates with age
      • Platinum-based regimens drive most of the effect
  • Reference:
    • MACH-NC (Radiother Oncol 2021); RTOG 91-11; NCCN/ASCO H&N.
Rodrigo Arrangoiz, MD (Oncology Surgeon)
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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