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Simultaneous Fractionated Cisplatin and Radiation Therapy in the Treatment of Advanced Operable Stage III and IV Squamous Cell Carcinoma of the Oral Cavity and Pharynx

Gus J Slotman*

Objective: To evaluate simultaneous fractionated cisplatin and radiation therapy in the treatment of advanced operable Stage III and IV squamous cell carcinoma of the oral cavity and pharynx.
Methods: A retrospective chart review of a database with Stage III and IV squamous cell carcinoma of the oral cavity and pharynx patients was conducted. A total of 105 patients with squamous cell carcinoma of the oral cavity and pharynx underwent chemoradiotherapy treatment of two types: CTRT consisted of pre-operative cisplatin, 20 mg/m2 intravenously for 4 consecutive days during weeks 1, 4, and 7 of radiotherapy; control chemotherapy consisted of several regimens: cisplatin, 75 mg/m2 intravenously on days 1, 22, and 43 of radiotherapy; carboplatin, 100 mg/m2 and taxol, 45 mg/m2 once per week during radiotherapy; or CTRT regimen following surgery. Toxicity to treatment, clinical response, biopsy result, incidence or recurrence, surgery, overall and disease-free survival were measured.
Results: A total of 91 patients underwent CTRT and 14 patients underwent control. Overall, CTRT experienced less high-grade toxicity (14% vs 50%, P<0.05). CTRT had trends of higher clinical complete response (73% vs 57%) and higher incidence of histologic complete response as evidenced by negative biopsy (67% vs 57%). Among patients who had post-treatment surgery, 48% of CTRT surgeries were radical compared to 100% of control surgeries (P=0.07). CTRT had less distant metastasis compared to control (7% vs 50%, P=0.06). Regarding expiratory status, CTRT had less death with disease (56% vs 75%, P=0.33). Kaplan-Meier analysis showed a trend toward increased long-term survival among CTRT compared to control.
Conclusion: Overall, CTRT experienced significantly less toxicity. CTRT showed trends toward higher clinical complete response and histologic complete response compared to control. CTRT also had trends toward less distant metastases and less death with disease compared to control.