Alternating chemotherapy: Gemcitabine and cisplatin with concurrent radiotherapy for treatment of advanced head and neck cancer

• Published in: Oral oncology Vol. 49; no. 3; pp. 249 - 254
• Main Authors: Aguilar-Ponce, J.L, Granados-García, M, Cruz López, J.C, Maldonado-Magos, F, Alvarez-Avitia, M.A, Arrieta, O, González-Ramírez, I, Lara-Cruz, G, Martinez-Juárez, I, Medina-Santillan, R, Castillo-Hernández, C, De la Garza-Salazar, J
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.03.2013; Elsevier
• Subjects: Adult; Alternating chemotherapy; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Chemoradiotherapy - methods; Chemotherapy; Cisplatin - administration & dosage; Cisplatin - therapeutic use; Concurrent chemoradiation; Deglutition Disorders - chemically induced; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Disease Progression; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Head and neck cancer; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; Induction Chemotherapy - methods; Leukopenia - chemically induced; Male; Medical sciences; Middle Aged; Neoplasm Staging; Oral cancer; Otolaryngology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Radiation-Sensitizing Agents - therapeutic use; Radiodermatitis - etiology; Radiotherapy; Radiotherapy Dosage; Remission Induction; Safety; Stomatitis - chemically induced; Survival Rate; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Xerostomia - chemically induced; Head and neck cancer; Chemotherapy; Oral cancer; Radiotherapy; Alternating chemotherapy; Concurrent chemoradiation; Antineoplastic agent; Gemcitabine; ENT; Chemoradiotherapy; Cancerology; ENT disease; Pyrimidine nucleoside; Platinum II Complexes; Stomatology; Malignant tumor; Cisplatin; Alkylating agent; Treatment; Antimetabolic; Pyrimidine derivatives; Oral cavity disease; Combined treatment; Fluorine Organic compounds; Cancer
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2012.09.008

Summary Background Many studies have shown gemcitabine and cisplatin are radiosensitizers. Concurrent chemoradiation seems to be an efficient approach for treatment of advanced head and neck cancer (HNC), but toxicity is significant. Objective To evaluate safety and explore efficacy of alternating chemotherapy with gemcitabine and cisplatin concurrent with radiotherapy in patients with advanced non-metastatic HNC. Patients and Methods Twenty-eight patients diagnosed with advanced Squamous Cell Carcinomas of the Head and Neck (SCCHN) in stages III (28%), IVa (36%), and IVb (36%) were treated with gemcitabine: 100 mg/m2 alternating with cisplatin: 50 mg/m2 concurrent with radiotherapy at doses of 2 Gy/day until completing 70 Gy. While awaiting for concurrent treatment, eleven patients received induction chemotherapy with cisplatin: 100 mg/m2 and 5-FU: 1000 mg/m2 . Toxicity, especially in relation to mucositis, xerostomy, dysphagia, leucopenia and radiodermitis was evaluated. Results 5-year progression-free survival was 27.8 ± 17.2% (CI-95: 0–61.5) and overall survival was 55.9 ± 11% (CI: 34.4–77.5). Overall response rate was 93%; complete response was 64.3% and partial response was 28.6%. Extensive surgery for primary site was avoided in 19 patients (70.4%). Grade 3–4 adverse events were mucositis (46.4%), leucopenia (14.2%), dysphagia (25%), xerostomy (10.7%) and radiodermitis (3.6%). Response rates and toxicity were not significantly different among those patients with and without induction chemotherapy, but survival was higher in patients receiving induction. Conclusions Gemcitabine alternating with cisplatin concurrent with radiotherapy is an active and safe treatment that deserves further study.