Concurrent chemoradiotherapy for squamous cell carcinoma of the oropharynx

Subjects were 34 patients, 32 men and 2 women, with squamous cell carcinoma of the oropharynx, with a median age of 63 years (range, 47 to 72 year). Subsites were the lateral wall in 18, anterior wall in 10, posterior wall in 5 and superior wall in 1. Nine had stage III disease and 25 had stage IV disease. Nineteen cases were resectable and 15 cases were unresectable. The patients were treated with concurrent chemoradiotherapy. The treatment regimen consisted of 5-fluorouracil (5-FU) and cisplatin (CDDP). 5-FU was given at 1000 mg/m2 per day as a continuous infusion over 4 days, and CDDP was given at 60 mg/m2 on day 4 after the start of 5-FU administration. Two courses of chemotherapy were administered, on day 1 and day 35. Radiation was given at a single daily fraction of 2 Gy and 5 fractions per week were administered up to a total dose of 58 to 70 Gy. Radiation break was scheduled from day 26 to 35. The median total delivered dose of radiation was 66 Gy. Toxicities included mucositis (grade 3, 23.6%, grade 4, 38.2%), vomiting (grade 3, 14.7%) and leukopenia (grade 3, 20.6%). Twenty-eight patients (82.3%) received the treatment as scheduled. Seven (22.6%) showed a complete response and 22 (70.9%) showed partial response. The mean overall survival rate was 23 months (4.5-73.5) and progression-free survival (PFS) rate was 20 months (4.5-71.3). The two-year preservation rate of the oropharynx without recurrence was 45.0%. The two-year overall survival (OS) rate was 57.1% and PFS rate was 55.1%. Significant differences among groups were observed in the two-year overall survival and progression-free survival rate, as follows: 84.6% and 88.8%, respectively, in the resectable cases, and 33.3% and 26.7%, respectively, in the unresectable cases, and 60.6% and 63.2%, respectively, in the T2+3 cases and 40.0% and 0%, respectively in the T4 cases. Failure patterns were noted in 15 cases with locoregional recurrence in 14 and other disease in one. Based on the results it is concluded that concurrent chemoradiotherapy is effective for preserving the oropharynx in a high percentage of patients and for improving the two-year OS and PFS rates without compromising the quality of life (QOL). (author)