B.I.D. Radiotherapy and Chemotherapy With CDDP/5-FU in Unresectable Pharyngeal Carcinoma: 10 Years Experience at the Centre Antoine-Lacassagne. Impact of Tumoral EGFR Level on Response and Survival

William Levin, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001

Presenter: R.J. Bensadoun
Presenter's Affiliation: Radiotherapy, Centre A-Lacassagne, NICE, France
Type of Session: Scientific

Background

Combination chemotherapy/radiation therapy regimens are increasingly being employed in the management of advanced head and neck cancers.

There is emergening evidence that the proliferation of certain solid tumors is stimulated by various growth factors that bind to cell surface receptors.

Materials and Methods

This is a retrospective analysis of patients with unresectable pharyngeal cancer treated with combination chemotherapy and twice daily radiation therapy.

Analysis was of 92 patients treated at a single institution.

All patients had unresectable stage IV squamous cell carcinoma of the oropharynx or hypopharynx.

Patients received continuous b.i.d. radiotherapy (2 daily fractions of 1.2 Gy, 5 days a week).

Total dose was 80.4 Gy for oropharyngeal tumors and 75.6 Gy for hypopharyngeal tumors.

Two or three chemotherapy courses of cisplatin (CP)/5-fluorouracil (5FU) were given during radiotherapy at 21-day intervals.

Results

There was a significant incidence of acute toxicity; 89% incidence of grade III/IV mucositis; grade III dermatitis (72%); grade III/IV neutropenia (61%).

Overall survival at one and two years was 72% and 50% respectively.

Univariate and multivariate analysis identified several factors associated with longer survival, these included; good performance status; tumor location (oropharynx); decreased levels of EGFR.

Author's Conclusions

These results confirm the efficacy of concomitant b.i.d. radiotherapy and chemotherapy in advanced unresectable tumor of the pharynx.

The overexpression of EGFR predicts a worse outcome in these patients.

Clinical/Scientific Implications

Compared to historical studies examining single modality therapy, concurrent chemoirradiation appears to be more efficacious in the treament of advanced head and neck cancers.

Biologic therapies targeting growth factor receptors may further increase tumor control in these patients.

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