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Cisplatin Enhances Radiotherapy in Locally Advanced Head and Neck Cancer

Cisplatin Enhances Radiotherapy in Locally Advanced Head and Neck Cancer

LISBON, Portugal—For patients with locally advanced head and neck
cancer, coupling cisplatin (Platinol) with radiotherapy leads to longer
survival and fewer recurrences than does radiation alone, according to the
first results of EORTC study 22931.

This randomized phase III trial was jointly conducted by the Head and Neck
and Radiotherapy groups of the European Organization for Research and Treatment
of Cancer (EORTC).

Jacques Bernier, MD, of the Oncology Institute of Southern Switzerland,
Bellinzona, presented the results at the 11th European Cancer Conference (ECCO
abstract 989). He said that EORTC investigators from 23 centers in 12 countries
enrolled 334 patients with cancer of the oral cavity, oropharynx, hypopharynx,
or larynx.

Eligible patients had stage T3-T4 disease, or T1-T2 disease with two to
three positive nodes and no metastases, or T1-T2 disease with fewer than two
positive nodes plus a high risk factor, such as perineural involvement.
"Importantly, two thirds of patients were stage T3-T4," Dr. Bernier
said.

After undergoing primary surgery performed with curative intent, study
participants were randomized to receive either radiotherapy alone, consisting
of 66 Gy given in 33 fractions over 6.5 weeks, or the same radiation schedule
paired with cisplatin 100 mg/m² on days 1, 22, and 43. Dr. Bernier pointed out
that two thirds of surgical procedures achieved tumor-free margins.

Although patients treated with cisplatin experienced significantly more
functional mucosal reactions, they showed no significant excess of objective
mucosal reactions.

Cisplatin was responsible for grade 3-4 leukopenia in 14% of patients, grade 3-4 granulocytopenia in 11%, grade 3-4
thrombocytopenia in 2%, grade 3-4 nausea in 11%, and grade 3-4 vomiting in 10%.
Notwithstanding these side effects, two thirds of patients completed two of the
planned three cycles of chemotherapy, and half completed all three cycles.

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