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Clinical Trial
. 2005 Aug 8;93(3):279-86.
doi: 10.1038/sj.bjc.6602696.

Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison

K-C Soo  1 , E-H Tan, J Wee, D Lim, B-C Tai, M-L Khoo, C Goh, S-S Leong, T Tan, K-W Fong, P Lu, A See, D Machin
Affiliations
Clinical Trial

Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison

K-C Soo et al. Br J Cancer. .

Abstract

We compared concurrent combination chemotherapy and radiotherapy with surgery and adjuvant radiotherapy in patients with stage III/IV nonmetastatic squamous cell head and neck cancer. Patients with non-nasopharyngeal and nonsalivary resectable squamous cell head and neck cancer were randomised to receive either surgery followed by adjuvant radiotherapy (60 Gy over 30 fractions) or concurrent combination chemotherapy and radiotherapy (66 Gy in 33 fractions). Combination chemotherapy comprised two cycles of i.v. cisplatin 20 mg m(-2) day(-1) and i.v. 5-fluorouracil 1000 mg m(-2) day(-1), both to run over 96 h given on days 1 and 28 of the radiotherapy. A total of 119 patients were randomised. At a median follow-up of 6 years, there was no significant difference in the 3-year disease-free survival rate between the surgery and concurrent chemoradiotherapy (50 vs 40% respectively). The overall organ preservation rate or avoidance of surgery to primary site was 45%. Those with laryngeal/hypopharyngeal disease subsite had a higher organ-preservation rate than the rest (68 vs 30%). Combination chemotherapy and concurrent irradiation with salvage surgery was not superior to conventional surgery and postoperative radiotherapy for resectable advanced squamous cell head and neck cancer. However, this form of treatment schedule with a view to organ-preservation can be attempted especially for those with laryngeal/hypopharyngeal and possibly oropharyngeal disease subsites.

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Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Outcome of patients in C requiring salvage surgery.
Figure 3
Figure 3
Disease-free survival by treatment. Three patients in S relapsed before completion of radiotherapy. The date of surgery was thus taken as the date of treatment completion. Another patient who died within a week of completion of salvage surgery was considered disease-free.
Figure 4
Figure 4
Overall survival by treatment.
See this image and copyright information in PMC

Comment in

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