- Email: [email protected]
Cisplatin as a radiosensitizer in the treatment of locally advanced head and neck cancer
Oral Oncology (2005) 41, 435
http://intl.elsevierhealth.com/journals/oron/
LETTER TO THE EDITOR
Cisplatin as a radiosensitizer in the treatment of locally advanced head and neck cancer We read with great interest the article by Sapundzhiev et al.1 In their prospective study, they examined the effectiveness of radiochemotherapy on lymph node metastases in patients with stage IV oropharyngeal cancer. They use carboplatin alone in 7 patients, 5-FU+Mitomycin-C in 8 patients, pacliataxel alone in one, carboplatin + paclitaxel in one patient as a radiosensitizer. Local control was achieved in 14/17 (82.4%) patients and regional––in 10/17 (58.8%) patients. They observed high incidence of vital LN metastases (of 566 LN studied, 29 exhibited signs of involvement). We want to comment on chemotherapeutic agents used as a radisensitizer in this study. Forastiere et al.2 showed that radiotherapy with concurrent administration of cisplatin is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for laryngeal preservation and locoregional control in advanced laryngeal cancer. Recently published two important randomized trials also clearly showed that in patients with operable high-risk head and neck cancer, concurrent use of radiotherapy and chemotherapy is superior to radiotherapy alone in regard to disease free survival and/or overall survival.3,4 In these trials, in concurrent arm, radiotherapy was combined with cisplatin which is the most common and effective radiosensitizer among all chemotherapeutic agents. In the light of the above information, we suggest that cisplatin may be more effective than the other chemotherapeutics as a radiosensitizer in the treatment of head and neck cancer. It should be considered as a first choice radiosensitizer unless contraindicated.
References 1. Sapundzhiev NR, Barth PJ, Vacha P, et al. Effectiveness of radiochemotherapy on lymph node metastases in patients with stage IV oropharyngeal cancer. Oral Oncol [in press]. 2. Forastiere AA, Goepfert H, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8. 3. Cooper JS, Pajak TF, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937–44. 4. Bernier J, Domenge C, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945–52.
Ozden Altundag Kadri Altundag Department of Medical Oncology Faculty of Medicine, Hacettepe University Ankara, Turkey Tel.: +1 713 795 0438; fax: +1 713 794 4385 E-mail address: altundag@sbcglobal:net Paolo Morandi Department of Medical Oncology S. Bortolo General Hospital Vicenza, Italy Emer Hanrahan Department of Breast Medical Oncology M.D. Anderson Cancer Center The University of Texas, Houston, TX, USA Address: 8181 Fannin Street no: 728 Houston, TX 77054, USA Received 15 October 2004; accepted 15 October 2004
1368-8375/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.oraloncology.2004.10.002
http://intl.elsevierhealth.com/journals/oron/
LETTER TO THE EDITOR
Cisplatin as a radiosensitizer in the treatment of locally advanced head and neck cancer We read with great interest the article by Sapundzhiev et al.1 In their prospective study, they examined the effectiveness of radiochemotherapy on lymph node metastases in patients with stage IV oropharyngeal cancer. They use carboplatin alone in 7 patients, 5-FU+Mitomycin-C in 8 patients, pacliataxel alone in one, carboplatin + paclitaxel in one patient as a radiosensitizer. Local control was achieved in 14/17 (82.4%) patients and regional––in 10/17 (58.8%) patients. They observed high incidence of vital LN metastases (of 566 LN studied, 29 exhibited signs of involvement). We want to comment on chemotherapeutic agents used as a radisensitizer in this study. Forastiere et al.2 showed that radiotherapy with concurrent administration of cisplatin is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for laryngeal preservation and locoregional control in advanced laryngeal cancer. Recently published two important randomized trials also clearly showed that in patients with operable high-risk head and neck cancer, concurrent use of radiotherapy and chemotherapy is superior to radiotherapy alone in regard to disease free survival and/or overall survival.3,4 In these trials, in concurrent arm, radiotherapy was combined with cisplatin which is the most common and effective radiosensitizer among all chemotherapeutic agents. In the light of the above information, we suggest that cisplatin may be more effective than the other chemotherapeutics as a radiosensitizer in the treatment of head and neck cancer. It should be considered as a first choice radiosensitizer unless contraindicated.
References 1. Sapundzhiev NR, Barth PJ, Vacha P, et al. Effectiveness of radiochemotherapy on lymph node metastases in patients with stage IV oropharyngeal cancer. Oral Oncol [in press]. 2. Forastiere AA, Goepfert H, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8. 3. Cooper JS, Pajak TF, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937–44. 4. Bernier J, Domenge C, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945–52.
Ozden Altundag Kadri Altundag Department of Medical Oncology Faculty of Medicine, Hacettepe University Ankara, Turkey Tel.: +1 713 795 0438; fax: +1 713 794 4385 E-mail address: altundag@sbcglobal:net Paolo Morandi Department of Medical Oncology S. Bortolo General Hospital Vicenza, Italy Emer Hanrahan Department of Breast Medical Oncology M.D. Anderson Cancer Center The University of Texas, Houston, TX, USA Address: 8181 Fannin Street no: 728 Houston, TX 77054, USA Received 15 October 2004; accepted 15 October 2004
1368-8375/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.oraloncology.2004.10.002