Table 4

Table 4. Overview of Single-agent-based Chemoradiotherapy Platforms for Head and Neck Cancer

Agent and studies Doses RT regimen Survival data (n) Comments
Cisplatin
Adelstein et al. (2003)^[24] 100 mg/m² every 3 weeks as CRT^a 70 Gy (once-daily fractionation) 37% 3-year OS (97)^b NPC only Commonly used standard of care. Superior to radiation alone. Still long-term survival remains poor. Many centers moved to combination CRT platforms based on results in phase II trials
Al-Sarraf et al. (1998)^[25] 100 mg/m² every 3 weeks as CRTa 70 Gy (once-daily fractionation) 76% 3-year OS (78)^c Commonly used standard of care. Superior to radiation alone. Still long-term survival remains poor. Many centers moved to combination CRT platforms based on results in phase II trials
Carboplatin
Jeremic et al. (1997)^[38] 25 mg/m² daily as CRT^a 70 Gy (once-daily fractionation) 55% 2-year OS (53)^d Limited data as a single agent. Carboplatin is less-well established as a radiosensitizer. Comparative data show no survival difference when compared with cisplatin but superior to RT alone
5-FU
Browman et al. (1994)^[41] 1200 mg/m²/day, 72 h infusion during weeks 1 and 3 of RT^a 66 Gy (once-daily fractionation) 63% 2-year OS (88)^a Commonly used in combined regimens (e.g. FHX or cisplatin/5-FU). Superior to radiation alone
Paclitaxel
Lovey et al. (2003)^[48] 2 mg/m² three times weekly as CRT 66–70 Gy (once-daily fractionation) 46% 2-year OS (26) Commonly used in combination (e.g. cisplatin/paclitaxel or TFHX)
Docetaxel
Calais et al. (2004)^[52] 20 mg/m² weekly as CRT 70 Gy (once-daily fractionation) 47% 3-year OS (63) Commonly used in combined regimens (e.g. cisplatin/docetaxel or DFHX)
Cetuximab
Bonner et al. (2006)^[69] 400 mg/m² loading, then 250 mg weekly^a 70 Gy (variable RT, including once-daily, hyper-fractionation and concurrent boost) 62% 2-year OS and 55% 3-year OS (211)^a Possible treatment standard, especially in the elderly and patients with poor performance status. Superior to radiation alone. Role compared with cytotoxic CRT remains unclear owing to control arm (RT only)
For each agent, one or two representative studies are shown and referenced. Selected trials are examples of primary/definitive CRT trials. ^aRandomized trial in comparison with RT alone. ^bTrial had three arms. Total patients enrolled = 295; 97 were treated with cisplatin-based CRT. ^c193 patients registered, 147 eligible for analysis (69 in radiotherapy arm, 78 in chemoradiotherapy arm). ^dTrial had three arms: RT alone (n = 53), cisplatin CRT (n = 53) and carboplatin CRT (n = 53).
Abbreviations: CRT, chemoradiotherapy; 5-FU, 5-fluorouracil; DFHX; docetaxel, 5-fluorouracil, hydroxyurea, and concurrent radiotherapy; FHX; 5-fluorouracil, hydroxyurea, and concurrent radiotherapy; HNC, head and neck cancer; NPC, nasopharygeal carcinoma; OS, overall survival; RT, radiotherapy; TFHX; paclitaxel, 5-fluorouracil, hydroxyurea, and concurrent radiotherapy.

Agent and studies	Doses	RT regimen	Survival data (n)	Comments
Cisplatin
Adelstein et al. (2003)^[24]	100 mg/m² every 3 weeks as CRT^a	70 Gy (once-daily fractionation)	37% 3-year OS (97)^b NPC only	Commonly used standard of care. Superior to radiation alone. Still long-term survival remains poor. Many centers moved to combination CRT platforms based on results in phase II trials
Al-Sarraf et al. (1998)^[25]	100 mg/m² every 3 weeks as CRTa	70 Gy (once-daily fractionation)	76% 3-year OS (78)^c	Commonly used standard of care. Superior to radiation alone. Still long-term survival remains poor. Many centers moved to combination CRT platforms based on results in phase II trials
Carboplatin
Jeremic et al. (1997)^[38]	25 mg/m² daily as CRT^a	70 Gy (once-daily fractionation)	55% 2-year OS (53)^d	Limited data as a single agent. Carboplatin is less-well established as a radiosensitizer. Comparative data show no survival difference when compared with cisplatin but superior to RT alone
5-FU
Browman et al. (1994)^[41]	1200 mg/m²/day, 72 h infusion during weeks 1 and 3 of RT^a	66 Gy (once-daily fractionation)	63% 2-year OS (88)^a	Commonly used in combined regimens (e.g. FHX or cisplatin/5-FU). Superior to radiation alone
Paclitaxel
Lovey et al. (2003)^[48]	2 mg/m² three times weekly as CRT	66–70 Gy (once-daily fractionation)	46% 2-year OS (26)	Commonly used in combination (e.g. cisplatin/paclitaxel or TFHX)
Docetaxel
Calais et al. (2004)^[52]	20 mg/m² weekly as CRT	70 Gy (once-daily fractionation)	47% 3-year OS (63)	Commonly used in combined regimens (e.g. cisplatin/docetaxel or DFHX)
Cetuximab
Bonner et al. (2006)^[69]	400 mg/m² loading, then 250 mg weekly^a	70 Gy (variable RT, including once-daily, hyper-fractionation and concurrent boost)	62% 2-year OS and 55% 3-year OS (211)^a	Possible treatment standard, especially in the elderly and patients with poor performance status. Superior to radiation alone. Role compared with cytotoxic CRT remains unclear owing to control arm (RT only)