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CCRT has: 1. Synergistic benefit against head and neck cancers 2. Associated with high level of response in in-operable disease 3. Tumour-radiosensitizing properties of chemotherapy or novel agents 4. Preservation of function is a major endpoint of interest This study: efficacy of CCRT with a single agent carboplatin in locally advanced head and neck cancers
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Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers
Savita Lasrado, Kuldeep Moras, George Jawahar Oliver Pinto, Mahesh Bhat, Sanath
Hegde, Brijesh Sathian, Neil Aaron Luis
Asian Pacific Journal of Cancer Prevention, Vol 15, 2014
Presented by: dr. Imam ManggalyaSupervisor: dr. Johan Kurnianda, Sp.PD-KHOM
Journal reading Hematooncology
Introduction
• Head and neck cancers constitute 6% of all cancers worldwide (Vokes et al., 1993)
• Squamous cell carcinoma of the head and neck is one of the commonest cancers seen in developing countries. (Dinshaw et al., 2000)
• Locoregionally advanced stage at the time of presentation and diagnosis. (Shah and Ladd, 1995)
Carcinogenesis phenomenon
Hereditary
Hormones
Aging
Immune status
Radiation
Exposure
(Calcattera and Juillard, 1995)
Treatment Options
Stage I-II
• Single modality
Stage III-IV
• Multimodality
< 1980’s Locally advanced
• Site & resectability
• Performance status
• Comorbidity
(Al-Sarraf, 1998).
CCRT
• Synergistic benefit against head and neck cancers• Associated with high level of response in in-
operable disease • Tumour-radiosensitizing properties of
chemotherapy or novel agents • Preservation of function is a major endpoint of
interest • This study: efficacy of CCRT with a single agent
carboplatin in locally advanced head and neck cancers
(Pignon et al., 2000; Forastiere et al., 2013; Haddad et al., 2013)
Excluded
NasopharynxParanasal sinuses
and salivary glandsUknown primary of the head and neck
Population study
40 patients 18-70y (median 47.7)
St III-IV SCC non-metastatic
Time & Place
Father Muller Med college Mangalore
2008 - 2010
Evaluation
• Weekly toxicity Treatment induced side-effects (NCI-CTC)
• Netropenia w/ fever
• Clinical exam 2-3 mo
• Biopsy of suspected local, regional, distant recurrences
• Radiographic studies as indicated
Clinical response
CR
4w no mass
No new lesion
PR
Decrease 50% mass
PD
Increase > 25%
New lesion
SD
Between PR & PD
Tumour Sites
Histopathological Diff
0%
10%
20%
30%
40%
50%
60%
70%
Mucositis Gr I, 50%
Mucositis Gr II, 25% Mucositis Gr IV,
23%
Skin reactions Gr I, 50%
Trombocytopenia Gr I, 65%
Anemia Gr I, 24%
Acute toxicity
Response
CR65%
PR35%
6-12 w
70%8%
5%17%
1-year
Goodresponse
Death
Recurrence
Surgery
Discussion
• 40 cases studied 80% were males and 20% were females with a male to female ratio of 4:1
• Smoking and alcoholism emerged as chief contributory habits
• CCRT act systemically and potentially eradicate distant micrometastases (Seiwert et al., 2007; Herman et al., 2014)
• combined therapy has proven to be superior to radiotherapy alone in terms of overall survival, disease free survival and local control (Pignon et al., 2000; Zhu et al., 2012)
Why Carboplatin
• Fewer toxic effects on renal function, • less nausea and vomiting, • ability to give the drug on outpatient basis,• the existence of data suggesting that the regimen has a
radiosensitizing effect (Yang et al., 1995; Nam et al., 2007).
• Well tolerated (Eisenberger et al. 1998)• Better tolerated than Cisplatn without compromising
tumor response and survival in locally advanced cervical cancer & poor general condition (Nam et al., 2013)
Conclusion
• chemoradiation appears to have an emerging role in the primary management of head and neck cancers.
• CCRT produces impressive locoregional control with a seemingly low rate of distant metastasis.
• Several side effects but manageable
• It also has organ preservation capabilities.
• Improve survival compared to radiation alone
CRITICAL APRAISAL on
PROGNOSIS
Apakah jurnal prognosis ini valid?
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Ya
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Ya
• Apakah kriteria outcome dibuat obyektif dan tidak bias ?
Ya
• Apakah dilakukan adjustment untuk faktor prognostik yang penting?
Tidak
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tidak ?
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Ya, berguna
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Thank Youfor Your Kind Attention
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