To improve the local control rate and the prognosis of locally unresectable head and neck cancer patients, we studied the concurrent chemoradiotherapy. Between September 1996 and September 2000, thirty-eight patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3mg/m² on 5 days of the week and 5FU, 150mg/m² as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60Gy. In the 36 patients evaluable for response, 19 complete and 10 partial responses were noted, with an overall response rate of 81%. Oral mucositis and myelosuppression were the major side effects and dose limiting toxicity. This study demonstrates increase in survival among the responders (complete + partial) in the concurrent chemoradiotherapy setting. We concluded that this treatment strategy was beneficial. Further studies for patients with locally unresectable head and neck cancer are warranted.

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Two hundreds six patients with T2-4N0 tongue cancer, initially treated in National Cancer Hospital between 1982 and 1995, were retrospectively studied. One hundred fifty-two patients with T2N0 tongue cancer had surgery or radiation therapy against the primary lesions. Among them, 34 patients underwent elective neck dissection and pathological examination revealed metastatic lymph nodes in 15 cases (44%, 15/34). In 118 patients who did not undergo the neck dissection, regional recurrences were observed in 49 patients (42%, 49/118). From both analyses, the ratio of latent regional metastasis in cases with T2N0 tongue cancer is considered as 42% (64/152). As regional metastases were limited in submental, submandibular, upper deep jugular and middle deep jugular regions, supraomohyoid neck dissection is indicated for elective surgery. As the analysis of 49 T3N0 tongue cancer revealed the almost same results as those of T2N0 group, it is considered that the principle of the treatment against the latent regional metastasis is the same as those for the T2N0 one.

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Treatment results of 66 cases of T2N0 glottic cancer were reviewed for the years 1973-1997 at the Gunma Cancer Center. 43 cases were administered using radiotherapy as primary treatment and 23 cases were managed surgically. The local control rates of conventional radiotherapy and partial resection were 65% and 60% (3/5), respectivery. The rates of laryngeal preservation by conventional radiotherapy including partial resection after local recurrence and surgery were 77% and 13%. These results suggest that radiotherapy should be employed for primary treatment and that partial resection should be used as soon as possible for local recurrence, when it occurs. To improve local control rates of radiotherapy in T2N0 glottic cancer, it is necessary to consider hyperfractionation or dose-ractionation.

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In order to evaluate the efficacy and safety of concurrent CBDCA or CDDP and radiotherapy, previously untreated 33 T2N0 glottic carcinomas were treated with CBDCA at 100mg/m² once a week or CDDP at 4mg/m² four times a week given simultaneously for the conventional radiotherapy (2.5Gy×4/week) from November 1990. At the dose of 40Gy, patients were evaluated. NC cases underwent planned surgery and PR + CR cases continued this modality up to a dose of 65Gy. Kaplan-Meier 5-year overall survival rate was 88.1%. Toxicity was greater in the patients concurrent with a higher incidence of grade III neutropenia, thrombocytopenia, dermatitis. No toxic deaths occurrerd. We compared a results of this concurrent chemoradiotherapy to historical control consisted of 15 radiotherapy alone cases from 1988 to 1990. The result of the study shows advantage in terms of overall survival (p=0.04), but no advantage in overall survival with successful laryngeal preservation.

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A series of 191 previously untreated patients with glottic cancer T2N0, treated at our institution from 1979 to 1997, were reviewed. Radiotherapy (RT) and partial laryngectomy (PT) for preservation of the larynx were mainly selected since 1989. Organ preservation rates for RT and PT were 72.4% (76/105) and 94.1% (16/17), respectively. Cause-specific survival rates for every modality showed no significant differences and also most of the patients died of other causes. These results suggested that RT and PL were the first choice of modalities for glottic cancer T2N0 and that a predictive factor was necessary as well.

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Thirty-six patients, previously untreated,(7 with stage III and 29 with stage IV; 25 with respectable and 11 with unresectable) were treated with concurrent chemoradiotherapy. The primary site was identified in the hypopharynx in 9, sinuses in 8, larynx in 6, nasopharynx in 4, oropharynx in 4, oral cavity in 3, parotis in 1, unknown primary in 1 patients. Treatment consisted of 5-fluorouracil (5-FU), 1000mg/m² per day, given as continuous infusions during 4 days, and cis-platinum (CDDP), 60mg/m² were given on day 4 beginning on day 1 and 35 of a concurrent radiotherapy course. Radiation was given in single daily fraction of 2Gy, to a total dose of 60 to 70Gy. Radiation breaks were scheduled from day 26 to 35. Toxicities included mucositis (grade 3, 33%, grade 4, 11%), vomiting (grade 3, 44%), leukopenia (grade 3, 17%), anemia (grade 3, 3%). According to gastrointestinal toxicity, scheduled drug was given 81% for the second course. The mean total delivered dose of radiation was 65.4Gy. The mean duration of the radiotherapy interruption was 5.1 days. There was no death secondary to treatment. Twelve (33%) and 22 patients (61%) had clinical complete and partial response. This chemoradiotherapy regimen, although toxic, is tolerable with appropriate supportive intervention and loco-regional control is good.

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