Combined chemotherapy and radiotherapy improves head and neck cancer survival
Cancer Research UK scientists have found that a combination of chemotherapy and radiotherapy improves survival from advanced head and neck cancer in patients who are not able to have surgery.
People with locally advanced head and neck cancer - where the disease has spread to nearby tissue or lymph nodes - are typically treated with radiotherapy, either with or without surgery.
Many patients have surgery to remove their tumour, but some are unable to have an operation, either because they are in poor general health or because of where their cancer is situated.
But the UK Head and Neck (UKHAN) cancer group set out to investigate whether a combination of both radiotherapy and chemotherapy - or 'chemoradiation' - might be more effective than radiotherapy alone, as well as the best ways of combining the two treatments.
They analysed the ten-year outcomes of 966 patients with locally advanced head and neck cancer, some of whom had already undergone surgery.
Patients who had not had surgery were split into four groups according to the treatment they received: radiotherapy alone; chemotherapy given at the same time as radiotherapy; chemotherapy given after completing radiotherapy; and chemotherapy given both during and after radiotherapy.
Meanwhile, patients who had previously had surgery were either given radiotherapy alone, or chemotherapy at the same time as radiotherapy.
The researchers found that, amongst patients who had not had surgery, simultaneous treatment with certain chemotherapy drugs and radiotherapy was associated with fewer deaths and disease recurrences over the study period.
This is important because treatment for cancer that has come back can lead to loss of speech or normal swallowing.
According to the results, average survival was typically 4.7 years for patients who received chemotherapy and radiotherapy at the same time, compared with 2.6 years for patients who only received radiotherapy.
Event-free survival - a measure of how long patients remain free of disease - was 2.2 years for patients who received chemotherapy and radiotherapy together, but just one year in the radiotherapy group.
However, the results showed that patients who had already undergone surgery did not benefit from the addition of chemotherapy.
The researchers also noted that chemotherapy was of no benefit if given after radiotherapy, and that this approach doubled the rate of toxicity.
Publishing their findings in the Lancet Oncology journal, the researchers concluded that chemoradiation should become the standard approach for all patients with advanced head and neck cancer who would not benefit from surgery.
Professor Jeffrey Tobias, lead author and a Trustee of Cancer Research UK, said: "When the trial first began, the value of chemotherapy was uncertain. But this latest work confirms the genuine benefit of adding chemotherapy to standard radiotherapy treatments.
"We saw a clear reduction in the chance of the cancer coming back and a substantial improvement in overall survival. The chemotherapy used in this study was simple to deliver and inexpensive, so we're pleased with the results."
Tobias, J., Monson, K., Gupta, N., MacDougall, H., Glaholm, J., Hutchison, I., Kadalayil, L., & Hackshaw, A. (2009). Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial The Lancet Oncology DOI: 10.1016/S1470-2045(09)70306-7