Concurrent nonplatinum chemoradiotherapy most effective treatment in nonresected head and neck cancers

Patients with head and neck cancer who had undergone surgery did not benefit from postoperative chemotherapy in addition to radiotherapy treatment, according to the 10-year follow-up results of the U.K. Head and Neck 1 trial. However, in those patients who had not undergone surgery for their cancer, fewer recurrences and deaths were seen when concurrent chemotherapy and radiotherapy were given.

“Compared with radiotherapy alone, two courses of nonplatinum chemotherapy given concurrently with radiotherapy in patients without previous surgery significantly extended event-free survival by 1.2 years,” researchers wrote.

The trial, conducted by the U.K. Head and Neck group, examined 966 patients with head and neck cancer from 36 centers between January 1990 and June 2000. Those patients who had not previously undergone surgery were randomly assigned to one of four groups in a 3:2:2:2 ratio: radical radiotherapy alone; radiotherapy with two courses of chemotherapy given simultaneously on days one and 14 of radiotherapy (SIM alone); or on days 14 and 28 days after completing radiotherapy (SUB alone); or both (SIM+SUB).

Those patients who had undergone surgery were randomly assigned radiotherapy alone or SIM alone.

The primary endpoints were OS and event-free survival.

In patients without prior surgery, those patients assigned SIM alone had the longest OS (4.7 years); however, the difference between SIM and radiotherapy alone (2.6 years) was not statistically significant “probably because there were fewer OS events compared with event-free survival in the analysis of SIM alone vs. radiotherapy alone (293 deaths vs. 322 event-free survival events) and the effect size was smaller,” the researchers wrote.

In those patients with prior surgery, adding concurrent chemotherapy to radiation had no significant effect on OS (5.0 years vs. 4.6 years; P=.70) or event-free survival (3.7 years vs. 3.0 years; P=.85).

Tobias JS. Lancet Oncol. 2009;doi:10.1016/S1470-2045(09)70306-7.