Researchers affiliated with the UK Head and Neck (UKHAN1) trial have reported that concurrent chemoradiotherapy reduces recurrences and death in patients with advanced head and neck cancer. The details of this study appeared in an early online publication in Lancet Oncology on October 28, 2009.[1]

There have been several randomized and non-randomized clinical trials suggesting that the concomitant administration of platinum-based chemotherapy and radiotherapy is superior to radiotherapy alone for the treatment of patients with advanced head and neck cancer for local and regional control. Most trials, but not all, have also shown a survival advantage for combined treatment. Two randomized trials in the May 7, 2004 issue of the New England Journal of Medicine documented the effects of adding platinum-based chemotherapy to post-operative radiotherapy for the treatment of patients with advanced head and neck cancers. Researchers are still attempting to determine the optimal way to administer radiotherapy and chemotherapy to improve outcomes of patients with advanced head and neck cancer.

In the current study, an attempt was made to determine if concurrent chemoradiotherapy was more effective than giving radiotherapy followed by maintenance chemotherapy. This study included 966 patients with head and neck cancer treated between 1990 and 2000 in the UK. Chemotherapy in this study was methotrexate alone or vincristine, bleomycin, methotrexate, and 5-FU.

Seven-hundred thirteen patients in this study who had not undergone prior surgery were randomly allocated to be treated with one of the following regimens. Overall survivals (OS) and event-free survivals (EFS) are also reported:

• Radical radiotherapy alone (n=233), resulting in a median OS of 2.6 years and a median EFS of 1.0 years
• Concurrent chemoradiotherapy (n=166), resulting in a median OS of 4.7 years and a median EFS of 2.2 years
• Radiotherapy followed by chemotherapy (n=160), resulting in a median OS of 2.3 years and a median EFS of 1.0 years
• Concurrent chemoradiotherapy followed by chemotherapy (n=154), resulting in a median OS of 2.7 years and a median EFS of 1.0 years

Two-hundred fifty-three patients who had undergone radical surgery were randomly allocated to one of the following two regimens:

• Radiaotherapy alone (n=135), resulting in a median OS of 5.0 years and an EFS of 3.7 years
• Concurrent chemoradiotherapy (n=118), resulting in a median OS of 4.6 years and a median EFS of 3.0 years

These authors concluded: “Concurrent non-platinum chemoradiotherapy reduces recurrences, new tumors, and deaths in patients who have not undergone previous surgery, even 10 years after starting treatment. Chemotherapy given after radiotherapy (with or without concurrent chemotherapy) is ineffective. Patients who have undergone previous surgery for head and neck cancer do not benefit from non-platinum chemotherapy.”

Comments: Other studies have clearly shown the benefit of neoadjuvant and adjuvant platinum-based regimens in patients with advanced head and neck cancer. These data appear to be applicable only to patients receiving a non platinum-based regimen and could be of importance to patients who are not deemed fit enough to tolerate a platinum-based regimen. In addition, since this trial was carried out, the taxanes have emerged as very effective agents for the treatment of head and neck cancer. There is also active interest in evaluating new targeted agents for the treatment of head and neck cancers.

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