An article published Online First in The Lancet Oncology reports that giving chemotherapy at the same time as radiotherapy to patients who have not had surgery with locally advanced head and neck cancer more than doubles their event-free survival to 2.2 years. This compares with 1.0 years with radiotherapy alone. When possible, chemo-radiation should become the standard for all patients with advanced head and neck cancer in whom surgery is not recommended.
People who consume large amounts of alcohol or who smoke are at highest risk of head and neck cancer. The numbers are rising. Each year, there are about 7,500 new cases diagnosed in the UK and 45,000 in the US. Standard traditional treatment for these patients involves radiotherapy with or without surgery. However, recent research suggests that the addition of chemotherapy can increase survival. But it is still unclear how to combine these treatments. Some of the chemotherapy drugs can be toxic.
To supply more evidence, the UK Head and Neck (UKHAN) cancer group examined the effect of giving chemotherapy at the same time as or after radiotherapy, with or without surgery. There was a 10-year monitoring of the outcomes of 966 patients with locally advanced head and neck cancer.
Patients who had not undergone surgery were randomly assigned to one of four groups:
Group 1: radiotherapy alone (233 patients)
Group 2: two courses of SIM (simultaneous) chemotherapy given at the same time as radiotherapy (166 patients)
Group 3: after completing radiotherapy (SUB subsequent; 160 patients)
Group 4: both (SIM+SUB; 154 patients)
Patients who previously had surgery were randomly assigned to radiotherapy alone (135 patients) or SIM alone (118 patients).
The findings suggested that non-platinum-based chemotherapy given at the same time as radiotherapy reduced deaths and recurrences in patients without previous surgery. The toxicity was acceptable. On the other hand, patients who had undergone previous surgery did not benefit from the addition of chemotherapy.
Additionally, chemotherapy given after radiotherapy (SUB) was shown to be ineffective. It did not improve survival and doubled the rate of toxicity.
Among the 74 percent of patients who did not have surgery, the median survival time was 2.6 years in the radiotherapy group, and 4.7 in the SIM alone group, 2.3 in the SUB alone group and 2.7 years in the SIM+SUB group. The median event free survival (EFS) was 1.0 years in the radiotherapy group, 2.2 in the SIM alone group, 1.0 in the SUB alone group and 1.0 years in the SIM+SUB group.
The authors calculate approximately that compared with radiotherapy alone, for every 100 patients in the non-surgical group who were given chemotherapy at the same time as radiotherapy, there would be 11 fewer events such as recurrences, new tumours, or deaths by 10 years after the start of the treatment.
The authors remark that these findings show the long-term benefit of non-platinum agents that are: “inexpensive, relatively easy to deliver, and have lower toxicity then platinum therapies…[which] considerably improves the likelihood of completing treatment, essential for improving the chance of a cure.”
“Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial”
Jeffrey S Tobias, Kathryn Monson, Nirmal Gupta, Hugh MacDougall, John Glaholm, Iain Hutchison, Latha Kadalayil, Allan Hackshaw, on behalf of the UK Head and Neck Cancer Trialists’ Group
DOI: 10.1016/S1470-2045(09)70306-7
Written by Stephanie Brunner (B.A.)