Combination Therapy Beneficial for Head and Neck Skin Carcinomas, Study Suggests

Patients who have high-risk non-melanoma skin carcinomas of the head and neck may benefit from concomitant radiotherapy and chemotherapy, according to a UNC-led study. Their study is the first to report on multiple patients with these skin carcinomas treated simultaneously with radio-and chemotherapy.

Scientists with the UNC Lineberger Comprehensive Cancer Center reported their findings in the Sept. 26, 2011 online issue of the International Journal of Surgery.

Non-melanoma skin carcinoma (NMSC) is the most common malignancy worldwide with an incidence of over 1.3 million in the United States. These cancers occur in anatomic areas subject to frequent sun exposure such as the head and neck. Most of these cancers can be cured with local treatments such as surgery or radiation. Some cancers, however, are high risk, meaning they are biologically and clinically aggressive, and require more treatment, with characteristics such as large tumor size, regional nodal involvement or recurrent disease.

Because this patient population is small, there are limited data on optimal care for these cancers. Neil Hayes, MD, MPH, associate professor of medicine and senior author, explains, ” Combination therapy is often used to treat other types of cancer, but not non-melanoma skin carcinoma. Our study provides the first evidence that this approach might be effective for this high-risk type of cancer. Skin cancer incidence is increasing worldwide, so having a more comprehensive and effective treatment regimen will help the patients with the most aggressive forms of this disease.”

Combination Cancer Therapy
Chemotherapy drugs are most effective when given in combination (combination chemotherapy). The rationale for combination chemotherapy is to use drugs that work by different mechanisms of action, thereby decreasing the likelihood that resistant cancer cells will develop. When drugs with different effects are combined, each drug can be used at its optimal dose, without intolerable side effects.

For some cancers, the best approach is a combination of surgery, radiation therapy, and chemotherapy. Surgery or radiation therapy treats cancer that is confined locally, while chemotherapy also kills the cancer cells that have spread to distant sites. Sometimes radiation therapy or chemotherapy is given before surgery to shrink a tumor, thereby improving the opportunity for complete surgical removal. Radiation therapy and low-dose chemotherapy after surgery help to destroy any remaining cancer cells. The stage of the cancer often determines whether single therapy or a combination is needed. For example, early-stage breast cancer may be treated with surgery alone or surgery combined with radiation therapy, chemotherapy, or with all three treatments, depending on the size of the tumor and the risk of recurrence. Locally advanced breast cancer is usually treated with chemotherapy, radiation therapy, and surgery.

Sometimes combination chemotherapy is used not to cure but to reduce symptoms and prolong life. Combination chemotherapy can be useful for people with advanced cancers that are not suitable for radiation therapy or surgical treatment (for example, those with unresectable non–small cell lung cancer, esophageal cancer, or bladder cancer).