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Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio?
Int J Radiat Oncol Biol Phys. 2011 Oct 01; 81(2):346-52.IJ

Abstract

PURPOSE

To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin.

METHODS AND MATERIALS

The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Thirty-two patients (53%) were treated by concurrent chemoradiation, and 28 patients (47%) were treated by radiation therapy alone. Forty-five patients (75%) received radiation therapy after surgical resection, and 15 patients (25%) received primary radiation therapy. Thirty-five patients (58%) were treated by intensity-modulated radiotherapy.

RESULTS

The 2-year estimates of overall survival, local-regional control, and progression-free survival were 89%, 89%, and 79%, respectively, among patients treated by chemoradiation, compared to 90%, 92%, and 83%, respectively, among patients treated by radiation therapy alone (p > 0.05, for all). Exploratory analysis failed to identify any subset of patients who benefited from the addition of concurrent chemotherapy to radiation therapy. The use of concurrent chemotherapy was associated with a significantly increased incidence of Grade 3+ acute and late toxicity (p < 0.001, for both).

CONCLUSIONS

Concurrent chemoradiation is associated with significant toxicity without a clear advantage to overall survival, local-regional control, and progression-free survival in the treatment of head-and-neck cancer of unknown primary origin. Although selection bias cannot be ignored, prospective data are needed to further address this question.

Authors+Show Affiliations

Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, USA. allen.chen@ucdmc.ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20933340

Citation

Chen, Allen M., et al. "Radiation Therapy in the Management of Head-and-neck Cancer of Unknown Primary Origin: How Does the Addition of Concurrent Chemotherapy Affect the Therapeutic Ratio?" International Journal of Radiation Oncology, Biology, Physics, vol. 81, no. 2, 2011, pp. 346-52.
Chen AM, Farwell DG, Lau DH, et al. Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio? Int J Radiat Oncol Biol Phys. 2011;81(2):346-52.
Chen, A. M., Farwell, D. G., Lau, D. H., Li, B. Q., Luu, Q., & Donald, P. J. (2011). Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio? International Journal of Radiation Oncology, Biology, Physics, 81(2), 346-52. https://doi.org/10.1016/j.ijrobp.2010.06.031
Chen AM, et al. Radiation Therapy in the Management of Head-and-neck Cancer of Unknown Primary Origin: How Does the Addition of Concurrent Chemotherapy Affect the Therapeutic Ratio. Int J Radiat Oncol Biol Phys. 2011 Oct 1;81(2):346-52. PubMed PMID: 20933340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio? AU - Chen,Allen M, AU - Farwell,D Gregory, AU - Lau,Derick H, AU - Li,Bao-Qing, AU - Luu,Quang, AU - Donald,Paul J, Y1 - 2010/10/08/ PY - 2010/04/27/received PY - 2010/06/01/revised PY - 2010/06/03/accepted PY - 2010/10/12/entrez PY - 2010/10/12/pubmed PY - 2011/10/25/medline SP - 346 EP - 52 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 81 IS - 2 N2 - PURPOSE: To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin. METHODS AND MATERIALS: The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Thirty-two patients (53%) were treated by concurrent chemoradiation, and 28 patients (47%) were treated by radiation therapy alone. Forty-five patients (75%) received radiation therapy after surgical resection, and 15 patients (25%) received primary radiation therapy. Thirty-five patients (58%) were treated by intensity-modulated radiotherapy. RESULTS: The 2-year estimates of overall survival, local-regional control, and progression-free survival were 89%, 89%, and 79%, respectively, among patients treated by chemoradiation, compared to 90%, 92%, and 83%, respectively, among patients treated by radiation therapy alone (p > 0.05, for all). Exploratory analysis failed to identify any subset of patients who benefited from the addition of concurrent chemotherapy to radiation therapy. The use of concurrent chemotherapy was associated with a significantly increased incidence of Grade 3+ acute and late toxicity (p < 0.001, for both). CONCLUSIONS: Concurrent chemoradiation is associated with significant toxicity without a clear advantage to overall survival, local-regional control, and progression-free survival in the treatment of head-and-neck cancer of unknown primary origin. Although selection bias cannot be ignored, prospective data are needed to further address this question. SN - 1879-355X UR - https://www.unboundmedicine.com/medline/citation/20933340/Radiation_therapy_in_the_management_of_head_and_neck_cancer_of_unknown_primary_origin:_how_does_the_addition_of_concurrent_chemotherapy_affect_the_therapeutic_ratio L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(10)00882-5 DB - PRIME DP - Unbound Medicine ER -