[Combined chemo-radiotherapy in non-operable cervico-facial neoplasms. Final results of an experience with non-selected XXXX ].

@entity1 @entity135 @entity137 @entity5 @entity900 @entity1732 @entity1487
The management of advanced inoperable @entity135 is often based on a combined chemo-radiotherapy approach. No definitive conclusions on the effectiveness of this combination can be drawn from clinical trials because these @entity5 are heterogeneous and treatment schedules vary. Many scientific trials test highly toxic combinations, whereas not only good results but also low @entity137 are mandatory in the current practice. We report the results obtained in 90 consecutive @entity1 affected with inoperable @entity135 in stages III-IV, or relapsed after surgery. Chemotherapy consisted of a @entity900 / @entity1732 induction phase, followed by weekly administrations of @entity900 simultaneous with conventional irradiation. The objective remission rates, achieved at the end of the induction chemotherapy and the simultaneous chemo-radiotherapy phases, were respectively 55.5% and 84.5%. The @entity5 disappeared in 39% of cases, by the end of the whole treatment. With the Kaplan-Meier method, 3-year overall, progression-free and relapse-free survival rates were 21.20%, 22.25% and 38.75%, respectively. The overall survival rate, calculated with the "log-rank" test according to the stage and the site of the @entity5 , exhibited no significant differences. In contrast, significant differences (p < 0.05) were demonstrated, according to treatment intent (curative radical: 26%, vs palliative: 0%) and to the achievement of an objective response at the end of induction chemotherapy--i.e., 48% 3-year survival rate, vs 7% in chemotherapy resistant @entity5 @entity1 . When limiting the analysis to 72 radically irradiated @entity1 , however, the achievement of CR after induction chemotherapy lost its prognostic value. @entity137 was not substantially higher than with conventional irradiation. Our results are in agreement with literature data on this subject which, regarding survival, fail to prove such integrated treatments as ours better than irradiation alone. In contrast, the preliminary combination of chemotherapy and irradiation is clearly better for the @entity1 waiting to receive radiation therapy, because @entity5 volume and related symptoms markedly decrease after induction chemotherapy. Currently the best survival rates (about 50% at 3 years) with chemo-radiotherapy are obtained, in this kind of @entity5 , by combining @entity900 and continuous-infusion @entity1487 , simultaneous with irradiation. However, frequent and severe @entity137 is reported. Should such a modality be adopted in the current practice, @entity1 should be selected according to their medical conditions.
