SAN FRANCISCOChemotherapy given concomitantly with radiotherapy
improves disease-free survival rates in patients with stages III and IV
oropharynx carcinoma, according to final results of the 94-01 GORTEC study. The
findings were presented at the 43rd Annual Meeting of the American Society for
Therapeutic Radiology and Oncology (ASTRO plenary 2).
After a median follow-up of 63 months, the 5-year disease-free survival rate
was 30% for patients who received chemotherapy plus radiotherapy vs 15% for
those who received radiotherapy only (P = .025). The increase in survival
rates, however, was accompanied by an increased incidence of grade 3-4
"Adding chemotherapy to radiation therapy does improve local control
and does improve disease-free survival," said Jean Bourhis, MD, of the
Institut Gustave-Roussy, Villejuif, France. "However, there is a price
because both acute and late toxicity were enhanced."
Dr. Bourhis presented the results on behalf of Dr. Gilles Calais, of the
Department of Radiation Oncology, Hôpital Bretonneau, Tours, France, who was
not able to attend the ASTRO meeting. Dr. Calais is the lead author of the
Between July 1994 and September 1997, this phase III multicenter study
enrolled 226 European patients with locally advanced stage III/IV oropharynx
carcinoma. Patients received radiation therapy only (70 Gy in 35 fractions) or
radiation therapy plus three cycles of a 4-day course of carboplatin
(Paraplatin) 70 mg/m²/d and fluorouracil 500 mg/m²/d, given on days 1, 22, and 43.
The two arms were balanced for patient age, sex, stage, performance status,
histology, and primary tumor site. The most common tumor sites were the tonsils
and the base of the tongue.
Although it improved survival, chemoradiotherapy also resulted in an
increased incidence of acute and late toxicity. The rate of grade 3-4 mucositis
was 67% in patients treated with concomitant chemoradiation vs 36% for those
who received radiation therapy only. There was one toxicity-related death in
the combination arm.