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

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