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Alternating Chemotherapy and Radiotherapy in Locally Advanced Head and Neck Cancer: An Alternative?

Department of Clinical Oncology, S. Croce General Hospital, Cuneo, Italy

Key Words. Head and neck cancer • Chemoradiation

Correspondence: Marco Merlano, M.D., Clinical Oncology, S. Croce General Hospital, Via M. Coppino 26, 12100 Cuneo, Italy. Telephone: +390171616739 Fax: +390171616793; e-mail: mcmerlano{at}tiscali.it

Rapidly alternating chemotherapy and radiotherapy (ACR) is a minor variation of concurrent chemoradiation (CCR). This scheduling has been tested in advanced head and neck cancer and has shown superiority over standard radiation in some randomized trials with only marginally greater toxicity. This paper reviews ACR in advanced head and neck cancer. The hypothesis that this approach could have a better toxicity profile than CCR is discussed in light of the published clinical data. Efficacy is also discussed on the basis of available phase III trials. Published data indicate that rapidly alternating chemoradiation adds to toxicity less than CCR and results in comparable 3-year overall survival rates. In conclusion, ACR could be as active as, and possibly less toxic than, CCR. Comparative trials are highly recommended.