The Circular Evolution of Treatment for Advanced Operable Stage III and IV Squamous Cell Carcinoma of the Head and Neck (SCCHN): Standard of Care History and New Data on Fractionated Cisplatin Chemoradiotherapy.

BackgroundMultimodality treatments involving radical surgery followed by high-dose cisplatin-sensitized chemoradiotherapy (SCCRT) now are standard of care for Stages III and IV SCCHN, with 5-year survival remaining 25-50%. Simultaneous fractionated cisplatin and radiation therapy (CTRT) is promising.

Objective

to review SCCHN treatment history while evaluating parallel CTRT development.MethodsThe history of surgical, radiotherapy (RT), chemotherapy, immunotherapy, and multimodal SCCHN was reviewed. 187 Stages III/IV SCCHN CTRT patients (cisplatin 20 mg/M2 IV 4 consecutive days weeks 1, 4, of 7000-7400 cGy (RT)) were examined. CTRT results: CCR = Clinical Complete Response-no clinical tumor. PCR = Partial Clinical Response-clinical residual tumor. HCR = Histologic Complete Response-tumor-free biopsy of primary site. Statistics: Chi-squared, ANOVA, and Kaplan-Meier.ResultsFifty years of evolution in SCCHN Stage III/IV treatment identified curative surgery plus combined high-dose cisplatin/radiotherapy as standard of care, with 5-year survival <50% and significant toxicity, leading up to 40% not completing the third round of CCRT. CTRT data: All primary tumor sites included. Stage IV (74%) and Stage III (26%). T4/T3 = 89.9%. CTRT Toxicity: Grade 0 = 32.26%, 1 = 13.98%, 2 = 38.71%, 3 = 14.52%, 4 = 0.54%, and 5 = 0%. CCR overall 152/187 (81.28%). 182/187 (98%) biopsied, 145/182 HCR (79.67%). CTRT response did not vary by primary site, Stage, sex, and T category. 11 (6%) had surgery for residual disease post-CTRT. 51/187 (27.3%) recurred. Kaplan-Meier 5-year (71.58%) and 10-year (60.72%) overall survival; 5-year (63.01%) and 10-year (49.38%) disease-free survival.DiscussionAdvances have improved SCCHN local control, but survival remains sub-optimal. CTRT might be an alternative to surgery plus high-dose cisplatin chemoradiotherapy, potentially increasing organ preservation and survival with reduced operative morbidity and toxicity.