Concurrent Chemoradiation Therapy

A meta-analysis of 93 randomized prospective head and neck cancer trials published between 1965 and 2000 showed the following:[8][Level of evidence B4]

A meta-analysis of 93 randomized prospective head and neck cancer trials published between 1965 and 2000 showed the following:[8][Level of evidence B4]

The subset of patients receiving chemotherapy and radiation therapy had a 4.5% absolute survival advantage.

A meta-analysis of 93 randomized prospective head and neck cancer trials published between 1965 and 2000 showed the following:[8][Level of evidence B4]

Patients who received concurrent chemotherapy had a greater survival benefit than those who received neoadjuvant chemotherapy.

In a randomized trial of patients with locally advanced head and neck cancer, curative-intent radiation therapy alone (213 patients) was compared with radiation therapy plus weekly cetuximab (211 patients).[9] The initial dose of cetuximab was 400 mg/m2 of body-surface area 1 week before radiation therapy was started, followed by a weekly dose of 250 mg/m2 of body-surface area for the duration of the radiation therapy. This study allowed altered-fractionation regimens to be used in both arms.[9,10][Level of evidence A1]

In a randomized trial of patients with locally advanced head and neck cancer, curative-intent radiation therapy alone (213 patients) was compared with radiation therapy plus weekly cetuximab (211 patients).[9] The initial dose of cetuximab was 400 mg/m2 of body-surface area 1 week before radiation therapy was started, followed by a weekly dose of 250 mg/m2 of body-surface area for the duration of the radiation therapy. This study allowed altered-fractionation regimens to be used in both arms.[9,10][Level of evidence A1]

At a median follow-up of 54 months, patients treated with cetuximab and radiation therapy demonstrated significantly higher progression-free survival (PFS) (hazard ratio [HR] for disease progression or death, 0.70; P = .006).

In a randomized trial of patients with locally advanced head and neck cancer, curative-intent radiation therapy alone (213 patients) was compared with radiation therapy plus weekly cetuximab (211 patients).[9] The initial dose of cetuximab was 400 mg/m2 of body-surface area 1 week before radiation therapy was started, followed by a weekly dose of 250 mg/m2 of body-surface area for the duration of the radiation therapy. This study allowed altered-fractionation regimens to be used in both arms.[9,10][Level of evidence A1]

Patients in the cetuximab arm experienced higher rates of acneiform rash and infusion reactions, although the incidence of other grade 3 or higher toxicities, including mucositis, did not differ significantly between the two groups.