According to an article recently published in an early online version of BMC Cancer, administration of initial chemotherapy and radiation therapy at the same time improves outcomes compared to sequential administration in patients with advanced head and neck cancer.
Cancers of the head and neck comprise several types of cancer affecting the nasal cavity, sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. The American Cancer Society estimated that 11,000 people would die from head and neck cancer in 2005.
Stage IV head and neck cancer refers to the most advanced stage of cancer; cancer at this stage has spread extensively from its site of origin. Standard treatment for advanced head and neck cancer typically includes chemotherapy and radiation, particularly for patients who are not eligible for surgery.
Chemotherapy and radiation therapy can be administered at the same time (concurrent or concomitant), or one type of therapy can be administered following completion of the other therapy (sequential). Both concurrent and sequential strategies may include several different types of regimens. Researchers continue to evaluate various schedules and regimens of chemotherapy and/or radiation therapy for the treatment of head and neck cancer.
Researchers recently conducted a clinical trial to evaluate different regimens of chemotherapy and radiation therapy for the treatment of advanced head and neck cancer. This trial included 122 patients with stage IV head and neck cancer who were not eligible for surgery. Patients were treated between 1987 and 1995 and were given one of two treatment regimens: a sequential regimen consisting of chemotherapy followed by a course of chemotherapy plus radiation therapy; or a concomitant regimen of chemotherapy plus radiation therapy followed by one course of radiation therapy.
Patients treated with the concomitant regimen had improved outcomes:
- Anticancer responses were achieved in 90% of patients in the concomitant group, compared with 67% of patients in the sequential group.
- At 5 years, rates of patients who had died from the disease were 69% for those treated with concomitant therapy and 80% for those treated with sequential therapy.
- At 5 years, overall survival rates were 23.7% for patients treated with concomitant therapy and 14.7% for patients treated with sequential therapy.
- Severe mucositis (inflammation, pain, or ulceration of the lining of the mouth) occurred in 54% of patients treated with concomitant therapy, compared with 44% for those treated with sequential therapy.
- Side effects that continued for extended periods following treatment were similar between the two groups of patients.
The researchers concluded that concomitant administration of initial chemotherapy and radiation therapy for advanced head and neck cancer improves outcomes compared to sequential administration of chemotherapy and radiation therapy. Patients with advanced head and neck cancer should discuss their individual risks and benefits of various types of treatment regimens with their physician.
Reference: Graf R, Hildebrandt B, Tilly W, et al. A Non-Randomised, Single-Centre Comparison of Induction Chemotherapy Followed by Radiochemotherapy versus Concomitant Chemotherapy with Hyperfractionated Radiotherapy in Inoperable Head and Neck Carcinomas. BMC Cancer. 2006; 6: DOI:10.1186/1471-2407-6-30. 
