Relationship between clinical factors and the incidence of toxicity after intra-arterial chemoradiation for head and neck cancer

van den Broek, Guido B.; Balm, Alfons J.M.; van den Brekel, Michiel W.M.; Hauptmann, Michael; Schornagel, Jan H.; Rasch, Coen R.N.

doi:10.1016/j.radonc.2006.09.002

« Previous Next »Radiotherapy & Oncology
Volume 81, Issue 2 , Pages 143-150, November 2006

Relationship between clinical factors and the incidence of toxicity after intra-arterial chemoradiation for head and neck cancer

Guido B. van den Broek
- Department of Head and Neck Oncology and Surgery
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
- Corresponding author. Guido B. van den Broek, Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Alfons J.M. Balm
- Department of Head and Neck Oncology and Surgery
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
Michiel W.M. van den Brekel
- Department of Head and Neck Oncology and Surgery
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
Michael Hauptmann
- Molecular Biology
Jan H. Schornagel
- Medical Oncology, and
Coen R.N. Rasch
- Radiation Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

Received 31 January 2006; received in revised form 7 September 2006; accepted 12 September 2006. published online 23 October 2006.

Abstract

Background and purpose

Concomitant chemoradiation is more and more used for advanced head and neck cancer. It improves local control and survival compared to radiotherapy alone, but goes along with serious toxicity. This study was set up to determine the relationship between patient-, tumour- and treatment-related factors and acute/late toxicity after concomitant chemoradiation.

Patients and methods

One hundred and twenty-five consecutive patients with newly diagnosed inoperable stage III and IV head and neck cancer were enrolled for intra-arterial chemoradiation. There were 28 women (22%) and 97 men (78%) and the mean age was 55 years (range 30–80). One hundred and nine patients had stage IV disease (87%), 16 patients (13%) had stage III disease. Statistical analyses were performed to identify an association between factors and acute/late toxicity.

Results

There were eight treatment-related deaths (6%). Severe acute toxicity (grade 3–4), mainly mucositis and dysphagia as categorized by the RTOG toxicity criteria, was recorded in 51% of the patients. Leucopenia (grade 3–4) occurred in 39% and aspiration pneumonia in 20% of patients. Tracheotomy was necessary in 15 (12%) patients. Neurological complications during treatment occurred in 3 (2%) patients. Severe late toxicity occurred in 34% of the patients. The most important of these were pneumonia (14%), osteoradionecrosis (9%) and swallowing problems with permanent percutaneous gastrostomy (20%). Statistical analysis did show a significant association between site and severe acute mucositis (p=0.007), site and osteoradionecrosis (p=0.014) and age and xerostomia (p=0.004).

Conclusions

Chemoradiation is frequently associated with serious toxicity. Oral cavity tumours and older age are related to acute mucositis/osteoradionecrosis and xerostomia, respectively.

Keywords: Head and neck neoplasms, Chemoradiation, Intra-arterial infusions, RADPLAT, Univariable analysis, Toxicity