Radiotherapy and Concurrent Chemotherapy: a Strategy That Improves Locoregional Control and Survival in Oropharyngeal Cancer

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Abstract
In this issue of the Journal, Calais et al. (1), representing the French Groupe d'Oncologie Radiotherapie Tete et Cou (GORTEC), report a multicenter randomized comparison of radiotherapy and concurrent chemotherapy versus radiotherapy alone in patients with oropharyngeal cancer. Their results add to a growing list of trials that demonstrate superior survival and locoregional control with this combined-modality approach. A group of 222 eligible patients with stage III or IV locally advanced squamous cell carcinoma of the oropharynx were randomly assigned to receive standard daily fraction radiotherapy (2 Gy/day; total dose, 70 Gy), administered alone or with a 4-day regimen of carboplatin and 5-fluorouracil (5-FU), starting on days 1, 22, and 43. After a median follow-up of 35 months, 3-year overall survival (51% versus 31%; P = .02), 3-year disease-free survival (42% versus 20%; P = .04), and locoregional control (66% versus 42%; P = .03) exhibited a statistically significant improvement for combined treatment compared with radiotherapy alone. As observed in other comparative trials, the addition of platinum and 5-FU chemotherapy substantially increased mucocutaneous toxicity, consequent weight loss, and the requirement for feeding tubes. Treatment interruptions were longer for patients in the combined-modality group, but there was no difference in the overall treatment time or the frequency of treatment interruptions. Chemotherapy was discontinued after radiotherapy was completed, and thus 35% of the patients with delays in chemotherapy did not receive cycle three. Radiotherapy compliance was excellent, with 95% of the patients in both groups completing treatment.