Synchronous Chemoradiotherapy in Patients with Stage III and IV Head and Neck Cancer: Comparing Cisplatin with Capecitabine

Abstract

Purpose: To evaluate the efficacy of concurrent intravenous cisplatin versus oral capecitabine with radical radiotherapy in locally advanced squamous cell carcinoma of the head and neck. Materials and methods: Between January 2007 and December 2009, 60 patients with stage III/IV head and neck squamous cell carcinoma (0 to 1 performance status) were enrolled into this study. Thirty cases are given cisplatin 30 mg/m 2 IV infusion weekly for 6 weeks with conventional radiotherapy. The remaining thirty cases are given oral capecitabine 500 mg/m 2 twice daily, continuously for 28 - 35 days with conventional radiotherapy also. The radiotherapy dose was 4600 cGy in 20 fractions over 4 weeks to primary and neck nodes followed by boost to primary site and any residual disease 1500 - 2000 cGy in 6 to 8 fractions. Results: The median age was 53 (range 25 - 71) years; 10 cases had stage III disease, 36 cases IVa disease and 14 cases IVb disease. Seventy-three percent of patients completed the course of capecitabine and 80% completed prescribed cisplatin. There were no treatment-related deaths, grade 4 haematological toxicity or grade 3 renal toxicity in either arm. The complete response rate at 3 months was 77% (23/30 patients) in the capecitabine group and 60% (18/30) in the cisplatin group. Relapse occurred in 10/30 (33%) patients by 2 years in the capecitabine group and in 12/30 (40%) in the cisplatin group. On analysis of survival data, the median follow-up period was 35 ± 15 months for overall survival and 33 ± 10 months for disease free survival. The overall survival, and disease-free survival rates at 2 years were 67%, and 85%, respectively for the capecitabine group versus 60% and 73% for the cisplatin group. Conclusion: Synchronous chemo-radiotherapy with capecitabine was found to be very effective, with excellent response, local control and 3-year cancer-specific survival rates.