Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): In the present study, we evaluated the appropriate schedule of S-1 administration in combination with radiotherapy for T2N0 glottic cancer by investigating the safety and efficacy.
Materials/Methods: Between 2007 and 2016, 23 patients diagnosed with T2N0 glottic cancer and treated with chemoradiotherapy (CRT) were enrolled in this study. Sixteen patients were treated with daily administration of S-1 (80-120 mg/day) during the course of radiotherapy between March 2007 and June 2013. Briefly, they received the drug for 4 weeks followed by 2-week drug-free intervals, or for 2 weeks followed by 1-week drug-free intervals. The remaining 7 patients were treated with an alternate-day regimen (80 mg/day) intended to reduce severe mucositis between July 2013 and December 2016. Radiotherapy was given as a once-daily fraction at 2 Gy up to a total median dose of 70 Gy (range, 66-70). The rates of survival and local control were estimated by the Kaplan-Meier method, and the Log Rank test was used to evaluate the significance of the survival and local control. The CTCAE ver. 4.0 was used to grade toxicities, and the chi-squared test was used to compare the toxicity between the daily and alternate-day administration groups.
Results: The median follow-up of the daily and alternate-day administration groups was 76 months (range: 44-104 months) and 40 months (range: 14-50 months), respectively. One patient in the alternate-day administration group experienced local recurrence and underwent total laryngectomy at eight months after the completion of CRT. A comparison between the daily administration and alternate-day administration groups at 2 years showed that the overall survival rate was 100% vs. 100%, (p = 0.68), and the local control rate was 100% vs. 86% (p = 0.13). Grade 2+ mucositis was observed in 13 patients (81%) in the daily administration group and in 3 patients (43%) in the alternate-day administration group (p=0.0656). No Grade 3 mucositis was encountered in the alternate-day administration group. Opioid pain medication to reduce symptoms was used in 9 patients (69%) in the daily administration group and in 1 patient (14%) in the alternate-day administration group (p = 0.0618). An interruption of radiotherapy due to mucosal pain was carried out in 4 patients (25%) in the daily administration group and in no patients (0%) in the alternate-day administration group (p = 0.1455).
Conclusion: Our results suggest that an alternate-day administration regimen of S-1 for CRT might reduce mucositis without compromising the therapeutic effectiveness compared to a daily administration regimen. CRT with alternate-day administration of S-1 may therefore be a viable standard treatment option for T2N0 glottic cancer.
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