May 18, 2002
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Radiation Alone After Surgery Still the Standard for Head and Neck Cancer

A preliminary study has found no advantage to adding chemotherapy to radiation after surgery for treating advanced head and neck cancer patients. The findings of the research, to be presented at the American Society of Clinical Oncology meeting May 18, appear to set aside earlier data suggesting that a combination of chemotherapy and radiation would improve the odds of staying cancer-free after surgery. Results are published in abstract # 903 in the ASCO Program/Proceedings.

Recurrence and spread of head and neck cancer is common and fewer than half of these patients are expected to survive past five years. "Early studies suggested that combining certain chemotherapy drugs and radiation may have a synergistic effect in these patients," says Arlene Forastiere, M.D., professor of oncology and otolaryngology at the Johns Hopkins Kimmel Cancer Center and medical oncology co-chair of the study. "Our current study shows that adding the chemotherapy drug cisplatin to standard radiation treatment does not significantly reduce recurrence."

The study evaluated 407 patients who had surgery to remove their cancer and were at high risk for recurrence. After surgery, patients in one group received radiation alone and, in a second group, a combination of cisplatin and radiation.

In a preliminary analysis after two years, researchers found no significant difference between the two groups in the percentage of patients remaining cancer-free. The cancer recurred in 26 percent of patients receiving radiation alone and in 20 percent of those receiving chemotherapy and radiation. There also was no significant difference between the two groups in overall survival – 63 percent in the combination therapy group versus 57 percent who received radiation only.

Just over half (58 percent) of the patients getting combination therapy were able to take all three doses of chemotherapy. The others did not tolerate the full dose. These patients experienced more side effects, such as lower blood counts, nausea and mouth soreness, than those receiving radiation alone. Three patients (two percent of the total evaluated) receiving combination therapy died during the study. There were no deaths during the study in the radiation-only group. "The fact that many of these patients receiving combination therapy could not handle all of the chemotherapy suggests that we should look in another direction," explains Forastiere. "Adding targeted drugs and those with less side effects may be a better alternative."

For now, researchers say that the standard treatment for advanced head and neck cancer patients who have had surgery will remain radiation therapy alone.

The researchers studied head and neck cancers located in the larynx, or voice box, the pharynx, which is part of the throat, and the oral cavity. These cancers are diagnosed in approximately 37,800 patients every year, and about 11,100 Americans will die from the disease.

This research was funded by the National Cancer Institute.

Other research participants include Jay Cooper, from the New York University Medical Center, Thomas Pajak of the Radiation Therapy Oncology Group, John Jacobs, John Ensley, and Harold Kim, from Wayne State University, Scott Saxman, from the National Cancer Institute, Julie Kish, from the Lee Moffitt Cancer Center, Anthony Cmelak, from the Vanderbilt Cancer Center, Marvin Rotman, from SUNY Health Center at Brooklyn, NY, Mitchell Machtay, from the University of Pennsylvania Health System, K. S. Clifford Chao, from the Mallinckrodt Institute of Radiology, Christopher Schultz from the Medical College of Wisconsin, and Nancy Lee and Karen Fu from the University of California San Francisco.

American Society of Clinical Oncology (ASCO) Program/Proceedings, Abstract #903, Volume 21, 2002.

Related Web Sites:
The Johns Hopkins Kimmel Cancer Center:
American Society of Clinical Oncology:

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