The Role of Chemoradiotherapy in Treatment of Patients with Locally Advanced Head and Neck Cancer

The purpose of the study was to evaluate the effectiveness of chemoradiotherapy in combination with paclitaxel. Materials and methods. 46 patients with locally advanced head and neck cancer with morphologically verified squamous-cell cancer were examined. Two treatment methods were used: radiotherapy with modification by cisplatin and radiotherapy combined with paclitaxel. The patients were diagnosed with T3-4N1-3M0 (18 patients with oropharyngeal cancer, 8 patients with laryngeal cancer, and 20 patients with oral cancer). Stage III was in 12% of patients, stage IV – at 88%. 70.5% of patients had regional metastases at the start of treatment in stage N2-3. The average age of patients was 57 years old. In all cases, squamous cell carcinoma of different degrees of differentiation was verified. The general condition was evaluated according to the WHOG ECOG scale, at the time of beginning of treatment in all patients was 0-1. Results and discussion. The complete effect occurrence was 36.4 % in the group with modification by paclitaxel as compared to 25 % in the group with cisplatin. Paclitaxel treatment scheme does not present difficulties in realization and has no distinct acute side effects. After completion of chemoradiotherapy, 25 patients (54%) continued polychemotherapy with a taxane / cisplatin / 5-fluorouracil regimen. After 4 courses of chemotherapy, 13 patients (5 from the first group and 7 from the second) underwent various surgical interventions. After 12 months of follow-up, progression was recorded in 12 (50%) patients of the first group: 2 patients with laryngeal cancer, 5 – with oropharyngeal cancer and 4 with oral cancer. Only one patient of group 1 had distant metastases to the lungs after 10 months of follow-up. In the second group, progression was detected in 9 (40.9%) patients with oropharyngeal and oral cavity cancer. Progression was observed in the locoregional zone. Conclusions. The obtained results give us grounds to continue research in this direction. The investigated scheme of treatment has no difficulties in carrying out and expressed acute side effects. As to more pronounced radiation reactions in the second group, it is necessary to resort more often to accompanying therapy. Although the frequency of acute radiation reactions is higher in the group receiving radiotherapy in combination with paclitaxel, the effectiveness of treatment in this group was also higher than in comparison group. The incidence of complete effects in the paclitaxel modification group was 36.4% versus 25% in the cisplatin group. After 12 months the incidence of progression is higher in group 1. It is 50% of patients versus 40.9% in the second group.