Annals of Surgical Oncology

, 18:3479 | Cite as

Selective Organ Preservation in Operable Locally Advanced Head and Neck Squamous Cell Carcinomas Guided by Primary Site Restaging Biopsy: Long-Term Results of Two Sequential Brown University Oncology Group Chemoradiotherapy Studies

  • Harold J. Wanebo
  • Ritesh Rathore
  • Prakash Chougule
  • Michael R. DiSiena
  • R. James Koness
  • Robert G. McRae
  • Peter T. Nigri
  • Kathy Radie-Keane
  • Neal Ready
Head and Neck Oncology

Abstract

Objectives

The long-term outcomes of selective organ preservation in operable, locally advanced head and neck cancers in two sequential chemoradiotherapy (CRT) protocols (HN-53, HN-67) are reported.

Methods

A total of 65 patients were treated with CRT consisting of carboplatin (AUC = 1/week) and paclitaxel (60 or 40 mg/m2/week) with radiation (1.8 Gy/day). After 5 weeks of CRT, if primary site biopsies were pathologically negative, then completion CRT to 67–72 Gy was done with neck dissection in node-positive cases. Alternatively, a positive rebiopsy required primary site resection and neck dissection followed by radiotherapy boost as deemed necessary.

Results

Pathologic complete responses occurred in 71% patients who then completed CRT; the remaining 29% patients underwent primary site surgery. The 5-year and median overall survival were 47% and 57 months with no statistically significant differences between the two groups. Overall long-term failure rates were: 6% local, 6% regional, and 32% distant.

Conclusions

This strategy of selective organ preservation was effective in 71% patients with CRT, whereas salvage surgery was required in the remainder. Long-term survival was equivalent in both treatment groups.

Keywords

Paclitaxel Neck Dissection Percutaneous Endoscopic Gastrostomy Pathologic Complete Response Organ Preservation 

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Harold J. Wanebo
    • 1
  • Ritesh Rathore
    • 2
  • Prakash Chougule
    • 3
  • Michael R. DiSiena
    • 4
  • R. James Koness
    • 4
  • Robert G. McRae
    • 5
  • Peter T. Nigri
    • 5
  • Kathy Radie-Keane
    • 6
  • Neal Ready
    • 7
  1. 1.Division of Surgical OncologyLandmark Medical CenterWoonsocketUSA
  2. 2.Division of Hematology/OncologyRoger Williams Medical CenterProvidenceUSA
  3. 3.Maddock Center for Radiation OncologyWarwickUSA
  4. 4.Division of Surgical OncologyRoger Williams HospitalProvidenceUSA
  5. 5.Department of OtolaryngologyRhode Island HospitalProvidenceUSA
  6. 6.North Main Radiation OncologyProvidenceUSA
  7. 7.Division of Hematology/OncologyDuke Medical CenterDurhamUSA

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