Release: July 29, 2000
Contact: Kenneth Satterfield
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NEW STUDY OFFERS CLUES ON WHICH PATIENTS WITH HEAD AND NECK CANCERS ARE AT RISK FOR OCCULT DISEASE SPREAD
Certain chemoradiation protocols successfully attack head and neck cancers, but some patients ultimately develop distant metastases. A team of Tennessee researchers seek to identify those patients likely to harbor micrometastases and who could benefit from further systemic treatments.
San Francisco, CA -- A new research study from a team of head and neck surgeons from The Health Science Center, The University of Tennessee-Memphis, have determined that some patients with advanced head and neck cancer would benefit from additional systemic treatment designed to eradicate clinically unidentified tumors that spread to distant parts of the body. Their study is the first to evaluate the relative risk for having undetected distant metastasis when patients are initially treated with RADPLAT, a protocol of targeted chemoradiation.
The authors of the study, "Analysis of Risk Factors Predictive of Distant Failure Following Targeted Chemoradiation for Advanced Head and Neck Cancer," are Ilana Doweck MD, K. Thomas Robbins MD, and Francisco Vieira MD, all from the Department of Otolaryngology/Head and Neck Surgery, College of Medicine, The University of Tennessee, Memphis, TN. The findings were presented before the 5th International Conference on Head and Neck Cancer, being held July 29 through August 2, at the San Francisco Marriott, San Francisco, CA. More than 1,500 leading head and neck surgeons from the United States and 46 nations will gather to hear the latest medical research in the diagnosis, treatment, and reconstruction associated with head and neck cancer. The medical conference is sponsored by the American Head and Neck Society, www.headandneckcancer.org.
Background: The RADPLAT protocol has been used to improve the outcomes of patients with advanced cancer of the head and neck. The protocol, widely used at the University of Tennessee Health Science Center, consists of a novel drug infusion technique for delivering cisplatin (Diamminodichloroplatinum) directly into the tumor bed while minimizing the effects systemically. Radiotherapy is administered simultaneously; high dose cisplatin is rapidly infused during super selective angiography (radiography of vessels after injection of a radiopaque contrast material).
Use of RADPLAT in head and neck cancer patients has resulted in very high rates of complete response (90.5 percent) at the primary site while the complete response rate for regional nodes was 70.7 percent. The subsequent use of neck dissection in patients with bulky nodal disease resulted in an ultimate regional control rate of 91 percent. The five year survival rate for patients dying from their disease and overall survival are 53.6 percent and 38.8 percent, respectively.
Despite the improvement in loco-regional control of advanced head and neck cancer, the incident of distant metastases (spread of cancerous tumors to other sites within the body) increased in patients receiving RADPLAT. Accordingly, this study sought to identify who would benefit the most from new strategies designed to treat occult, or clinically unidentified metastases associated with the primary tumor.
Methodology: Between June, 1993, and March, 1999, 250 patients with advanced head and neck cancer were treated with intra-arterial cisplatin and radiotherapy (165 patients) and a sister protocol (85 patients) where pentoxifylin was added. Incidence and risk factors for distant metastasis included patient and tumor characteristics. Patients with local or regional recurrence of head and neck cancer (39 patients or 15.6 percent) were excluded from this analysis since the intent was to identify patients who had occult distant metastases at the time of diagnosis. Ten patients were excluded from the study due to loss to follow-up or failure to complete treatment.
The RADPLAT protocol was administered once weekly for four weeks. Patients were followed every day during the treatment protocol. Tumor response was determined during therapy by physical examination, and restaging was performed two months after radiation by means of criteria based on a physical examination, repeated CAT scans, or MRI studies. Neck dissection in patients with persistent nodal disease was performed two months after treatment.
Results: Of the 250 patients analyzed, 45 (18 percent) developed distant metastasis as the only site of failure. The mean interval for this event to occur was 9.8 + 1.4 months. The most common sites for the spread of the disease was the lung (30 patients), followed by the bone (13 patients), liver (13 patients), and brain (five patients).
The study revealed that the characteristics of the lymph node involvement at the initial diagnosis was found to have the most significant effect on the development of distant metastasis. Results indicated the most accurate prediction of distant metastasis was the number of neck levels with clinical evidence of disease. Specifically, approximately twice as many patients with more than one level of the neck involved had distant metastasis than those with only one level. The site of the tumor was the second independent variable which influenced the development of distant metastases. Patients with hypopharyngeal carcinoma had the highest incidence (43.2 percent).
Conclusions: The researchers conclude that patients who present with nodal disease and/or cancer of the hypopharynx have the greatest risk for having subclinical distant metastases and would benefit from additional systemic treatment.
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