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Regional control after concomitant chemoradiotherapy without planned neck dissection in node-positive head and neck squamous cell carcinomas

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Title: Regional control after concomitant chemoradiotherapy without planned neck dissection in node-positive head and neck squamous cell carcinomas
Authors: Sakashita, Tomohiro Browse this author
Homma, Akihiro Browse this author
Oridate, Nobuhiko Browse this author
Suzuki, Seigo Browse this author
Hatakeyama, Hiromitsu Browse this author
Kano, Satoshi Browse this author
Mizumachi, Takatsugu Browse this author
Onimaru, Rikiya Browse this author
Tsuchiya, Kazuhiko Browse this author
Yasuda, Koichi Browse this author
Shirato, Hiroki Browse this author
Fukuda, Satoshi Browse this author
Keywords: Head and neck cancer
Chemoradiotherapy
Lymph node metastasis
Cisplatin
Nodal control
Issue Date: Apr-2013
Publisher: Elsevier
Journal Title: Auris Nasus Larynx
Volume: 40
Issue: 2
Start Page: 211
End Page: 215
Publisher DOI: 10.1016/j.anl.2012.07.002
PMID: 22867524
Abstract: Objectives: Although three-weekly high-dose (100 mg/m(2)) cisplatin (three cycles) chemoradiotherapy has been considered a standard regimen for patients with advanced head and neck squamous cell carcinomas (HNSCC), this protocol is associated with significant acute and late toxicities. Therefore, weekly cisplatin at a dose of 40 mg/m(2) has been used at our institution since 2006. This retrospective study was aimed at assessing the oncologic efficacy of weekly cisplatin chemoradiotherapy for the control of nodal metastasis. Methods: We analyzed 28 patients with node-positive HNSCC treated with weekly cisplatin and concurrent radiotherapy. Computed tomography was performed 4-8 weeks after the completion of chemoradiotherapy to evaluate nodal response. If residual neck disease was apparent or suspected, we performed early salvage neck dissection (ND). In cases with a complete response (CR), we took a "wait and see" approach. When no viable tumor cells were observed in the surgical specimens obtained by ND, nodal metastasis was defined as controlled by weekly cisplatin chemoradiotherapy alone. Results: Nodal metastasis was evaluated as having a CR in 20 patients (71%). Eight patients (29%) underwent early salvage ND. Recurrent primary tumors were observed in the other four patients (14%). Salvage primary resection and associated ND were performed for these four patients. In 7 of 12 patients undergoing ND, no viable tumor cells were observed. In 23 of 28 patients, neck diseases were controlled by chemoradiotherapy alone (not including salvage by ND). In 27 of 28 patients, neck diseases were controlled by the overall treatment (including salvage by ND). The rate of nodal control by chemoradiotherapy alone and by the overall treatment was found to be 82.0% and 96.3%, respectively, using the Kaplan-Meier method. The three-year overall and disease free survival rates were 86.8% and 80.8%, respectively. Conclusion: Concomitant weekly cisplatin at a dose of 40 mg/m(2) chemoradiotherapy showed a good control rate of not only primary lesions but also neck diseases. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
Relation: http://www.sciencedirect.com/science/article/pii/S038581461200185X
Type: article (author version)
URI: http://hdl.handle.net/2115/52745
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 坂下 智博

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