Gemcitabine concurrent with radiation therapy for locally advanced head and neck carcinomas

Abstract

Background: Management of advanced head and neck carcinoma is a challenging proposition. Presently concomitant chemo-irradiation has become the standard of care in such patients. Many chemotherapeutic drugs have shown radio-sensitising effects when used concomitantly along with radiation. The present study was carried out with the objective of assessing the feasibility and efficacy of low dose gemcitabine as radiosensitizer when used during radical radiotherapeutic management of patients with locally advanced head and neck carcinomas.

Patients and methods: From November 2000 to March 2003, eighty histopathologically proven cases of squamous cell head and neck carcinoma were included in this trial, 40 patients were randomly assigned to receive radiotherapy alone and 40 patients to receive gemcitabine along with radiotherapy.

Results: All patients were assessable for toxicity and response. Severe mucositis (WHO level 5 reactions were observed in 67% patients in the CT/RT group vs 16% patients in the RT only group. No severe hematological toxicity was seen. The rates of complete and partial responses were 42.5% & 57.5% respectively for RT only and 62.5% &37.5%, respectively for CT/RT group. There was no significant difference in the response rates at the end of treatment but disease free survival at three years was better in the CT/RT group (63.3% vs 20%). Nine of the 17 patients with complete response in the radiation only group developed relapse while no relapses were seen in CT/RT group.

Conclusion: In the present study the combination of gemcitabine and radiotherapy has not shown any statistical difference in locoregional control but survival advantage was seen as compared to radiotherapy alone. At the same time more mucosal and skin toxicity was encountered when Gemcitabine is given concurrently with radiation.

Figure 1

Mean scores for cutaneous reactions (0=Nil, 1=Thershold erythema, 2=Erythema grade I, 3=Erythema and desquamation, 4=desquamation, grade 2, 5=Desquamation, blistering, 6=Moist exudation, grade 3) observed during radiation therapy and recovery period.

Figure 2

Mean scores for mucositis (0=No reaction, 1=Threshold erythema, 2=Definite erythema, 3=Patchy mucositis (less than half of field), 4=Patchy mucositis (more than half of field), 5=Confluent mucositis, 6= Confluent mucositis with bleeding) observed during radiation therapy and recovery period.

Figure 3

Mean scores for weight loss observed during radiation therapy and recovery period.