Combined concomitant boost radiotherapy and chemotherapy in stage III-IV head and neck carcinomas: A comparison of toxicity and treatment results with those observed after radiotherapy alone

Background: Alteration of radiation therapy (RT) fractionation and the combination of chemotherapy (CT) with RT represent two predominant fields of current research in the treatment of head and neck carcinomas. To assess the potential integration of these two fields, a retrospective comparison of toxicity and treatment outcome was carried out in stage III-IV patients treated with a concomitant boost RT schedule with or without CT. Patients and methods: Fifty-two patients were treated by RT alone and 35 by RT and CT. In the RT group, there were significantly fewer T3-4 tumors (56% vs. 88%, P = 0.002) and higher proportion of planned neck dissections (35% vs. 14%, P = 0.047). The planned total dose was 69.9 Gy delivered over 5.5 weeks. In 10 cases CT was given before RT and in 25 concomitantly with RT, either alone or with neoadjuvant and/ or adjuvant CT. All patients but two had cisplatin-based (CDDP, 100 mg/m(2)) CT, associated in 28 patients with 5-fluorouracil (5-FU, 1000 mg/m(2)/24 h x 5). The median follow-up for the surviving patients was 21 and 31 months for the RT and RT-CT groups respectively. Results: Grade 3-4 acute toxicity (RTOG) was observed in 73% and 86% of patients, and grade 3 dysphagia in 31% and 57% (P = 0.02) respectively in the RT and RT-CT groups. The rates of grade 3-4 late complications were similar in the two groups (5% vs. 12%). At three years, actuarial loco-regional control (LRC) was 57% and 66% (P = 0.66) and overall survival was 56% and 47% (P = 0.99) in the RT and RT-CT groups respectively. Conclusions: While acute toxicity was higher compared with RT alone, this accelerated RT schedule was feasible in association with 5-FU/CDDP, even administered concomitantly. Despite the significant proportion of more advanced disease in the RT-CT group, LRC was similar to that obtained by RT alone. Combinations of concomitant boost RT and chemotherapy merit further investigation in prospective trials.