Head and neck cancer and second round of treatment

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A newly released study has determined predictors that can better identify patients who will benefit from a potentially toxic second course of therapy, which offers a small but real chance of cure in select patients with head and neck cancer. Published early online in Cancer, a peer-evaluated journal of the American Cancer Society, the findings could help guide therapy decisions for head and neck cancer patients.

Radiation is often used to treat patients with head and neck cancer. If their cancer reappears, they have limited therapy choices: chemotherapy is not curative, and surgery can be curative but is often not possible. Chemotherapy and a second course of radiation have previously been shown to be another option. Joseph Salama, MD, formerly of the University of Chicago, and colleagues conducted an analysis of previous studies to determine how patients tolerate this second round of therapy and which patients benefit the most from it.

The researchers analyzed data from 166 patients with head and neck cancer who received a first round of radiation followed by a second round plus chemotherapy because their cancer recurred or they developed a new tumor. The second course of therapy could cure approximately 25 percent of patients at two years, but it was quite toxic. (Some patients lost the ability to speak or swallow. In addition, approximately 20 percent of patients died from therapy-related complications.)

Certain patients benefited from the therapy over others. Those who were cancer-free for a longer period of time, did not have chemotherapy with their first course of radiation, were treated with a higher dose of radiation in the second round, and had surgery previous to the second course of radiation were more likely to be cured at two years than those who had none or only one of these features. "These can help doctors determine which patients are best suited for a second course of radiation with chemotherapy for head and neck cancer," said Dr. Salama.

The authors concluded that for patients with recurrent head and neck cancer in a previously irradiated area, concomitant chemotherapy with reirradiation is a therapy option that offers a small but real chance of cure in select patients; however, due to the risk of severe toxicity, the therapy should be limited to investigational studies and experienced medical centers.


Posted by: Janet    Source