Chemotherapy and Radiotherapy in Head and Neck Cancer

60 Chemotherapy and Radiotherapy in Head and Neck Cancer


60.1 Chemotherapy


60.1.1 General Principles


• Role of neoadjuvant (before definitive treatment) aims to decrease tumour size, objective response rates range from 30 to 90%


• No increase in survival but may decrease mass, painful infiltration + regression of lung mets with increase in QoL


• No regimen has been able to induce complete responses, i.e., disappearance of all detectable evidence of cancer


• Adjuvant chemo is administered after primary treatment if patient has high risk of recurrence


• Chemo RT increases response rates and survival for unresectable stage III/IV disease. Relative risk of death decreases more for oropharynx and larynx if <60 years (compared with oral cavity and hypopharynx)


60.1.2 Agents


• Cisplatin:


figure Interferes with transcription, resulting in new mutations


figure Platinum-based drug “alkylating-like” agent


figure Cyclophosphamide is true alkylating agent


figure 28% response rate


figure Side effects: nausea and vomiting, renal failure, peripheral neuropathy, alopecia, electrolyte loss (Na, K, Mg)


• 5-Fluorouracil/methotrexate:


figure Antimetabolite, impairs normal production of nucleotides


figure 15% response rate


figure Side effects: nausea and vomiting, mucositis, photosensitivity, myelosuppression


• Paclitaxel:


figure Mitotic inhibitor


figure Interferes with microtubules disrupting cell division


figure 38% response rate


figure Side effects: peripheral neuropathy, alopecia, nausea and vomiting, myelosuppression


• Vincristine/vinblastine:


figure Plant derivatives


figure Prevent spindle formation during mitosis by binding to tubulin, leading to metaphase arrest


figure Side effects: neuropathy


• Actinomycin D, bleomycin, doxorubicin:


figure Antitumour antibiotics


figure Intercalate between DNA base pairs, preventing cell division


figure Side effects: myelosuppression, cardiotoxicity, alopecia


• Cetuximab:


figure Monoclonal antibody directed against epidermal growth factor receptor, which is a growth-promoting protein that is overexpressed in the majority of SCC in H&N


figure Combined with RT in locoregional advanced H&N cancer provides 10% increased overall survival compared with RT alone


figure No RCTs looking at chemo RT ± concurrent cetuximab


figure Indicated in patients not fit enough for concurrent chemo + RT


60.1.3 Complications of Chemotherapy


• Acute:


figure Myelosuppression—anaemia, thrombocytopenia, neutropenia


figure Nausea and vomiting


figure Diarrhoea


figure Soft tissue necrosis with extravasation


figure Alopecia


• Late:


figure Renal failure


figure Haemorrhagic cystitis


figure Neurotoxicity (peripheral neuropathy)


figure Cardiotoxicity—acute arrhythmias


figure Pulmonary toxicity—fibrosis


figure Infertility


figure Second malignant neoplasms, e.g., leukaemia


60.2 Radiotherapy


60.2.1 General Principles

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Chemotherapy and Radiotherapy in Head and Neck Cancer

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