Questions About Cancer? 1-800-4-CANCER

Oropharyngeal Cancer Treatment (PDQ®)

Health Professional Version
Last Modified: 12/12/2013

Stage III Oropharyngeal Cancer

Current Clinical Trials

The management of stage III carcinomas of the oropharynx is complex and requires multidisciplinary input to establish the optimal treatment.

Standard treatment options:

  1. A combination of surgery with postoperative radiation therapy or postoperative chemoradiation for selected high-risk patients.[1]

  2. Radiation therapy for patients with cancer of the tonsil.[2] Hyperfractionated radiation therapy yields a higher control rate than standard fractionated radiation therapy for patients with stage III cancer of the oropharynx,[3] but this has not resulted in an increase in overall survival.[4][Level of evidence: 1iiA]

  3. Chemoradiation therapy.[5-8]

New surgical techniques for resection and reconstruction developed in the last 7 to 10 years that provide access and at least partial function restoration have extended the surgical options. External-beam radiation therapy augmented with interstitial implantation and multiple daily treatment schemes have given new insights into the use of radiation for this group of tumors.[9] All of these patients may be considered for entry into neoadjuvant chemotherapy trials.

In general, the preferred treatment has been to combine surgery with postoperative radiation therapy when possible, as shown in the RTOG-7303 trial, for example.[1] This approach has become the standard in this specific grouping whenever it can be applied. Aggressive radiation therapy alone will give equivalent control rates to surgery for cancers originating in the tonsil or on the base of the tongue.[2,10]

Specific surgical procedures and their modifications are not designated here because of the wide variety of surgical approaches to the area, the variety of opinions about the role of modified neck dissections, and the multiple reconstructive techniques that may give the same results. This group of patients should be managed by surgeons who are skilled in the multiple procedures available and actively and frequently involved in the care of these patients.

Treatment options under clinical evaluation:

  1. Neoadjuvant chemotherapy as given in clinical trials has been used to shrink tumors and thereby render them more definitively treatable with either surgery or radiation. Chemotherapy is given prior to the other modalities, hence the designation neoadjuvant to distinguish it from standard adjuvant therapy, which is given after or during definitive therapy with radiation or after surgery. Many drug combinations have been used in neoadjuvant chemotherapy.[11-15]

  2. Chemotherapy has been combined with radiation therapy in patients who have locally advanced disease that is surgically unresectable, as shown in several trials, including RTOG-9911, EORTC-24971, and NCT00273546.[16-25] The best chemotherapy to use and the appropriate way to integrate the two modalities is still unresolved.[26]

  3. Radiation clinical trials, such as RTOG-8313, for example, have evaluated hyperfractionation schedules and/or brachytherapy and should be considered.[27]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III oropharyngeal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References
  1. Tupchong L, Scott CB, Blitzer PH, et al.: Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03. Int J Radiat Oncol Biol Phys 20 (1): 21-8, 1991.  [PUBMED Abstract]

  2. Mendenhall WM, Amdur RJ, Stringer SP, et al.: Radiation therapy for squamous cell carcinoma of the tonsillar region: a preferred alternative to surgery? J Clin Oncol 18 (11): 2219-25, 2000.  [PUBMED Abstract]

  3. Horiot JC, Le Fur R, N'Guyen T, et al.: Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 25 (4): 231-41, 1992.  [PUBMED Abstract]

  4. Bourhis J, Lapeyre M, Tortochaux J, et al.: Phase III randomized trial of very accelerated radiation therapy compared with conventional radiation therapy in squamous cell head and neck cancer: a GORTEC trial. J Clin Oncol 24 (18): 2873-8, 2006.  [PUBMED Abstract]

  5. Denis F, Garaud P, Bardet E, et al.: Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22 (1): 69-76, 2004.  [PUBMED Abstract]

  6. Olmi P, Crispino S, Fallai C, et al.: Locoregionally advanced carcinoma of the oropharynx: conventional radiotherapy vs. accelerated hyperfractionated radiotherapy vs. concomitant radiotherapy and chemotherapy--a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55 (1): 78-92, 2003.  [PUBMED Abstract]

  7. Bernier J, Domenge C, Ozsahin M, et al.: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350 (19): 1945-52, 2004.  [PUBMED Abstract]

  8. Semrau R, Mueller RP, Stuetzer H, et al.: Efficacy of intensified hyperfractionated and accelerated radiotherapy and concurrent chemotherapy with carboplatin and 5-fluorouracil: updated results of a randomized multicentric trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 64 (5): 1308-16, 2006.  [PUBMED Abstract]

  9. Puthawala AA, Syed AM, Eads DL, et al.: Limited external beam and interstitial 192iridium irradiation in the treatment of carcinoma of the base of the tongue: a ten year experience. Int J Radiat Oncol Biol Phys 14 (5): 839-48, 1988.  [PUBMED Abstract]

  10. Mendenhall WM, Morris CG, Amdur RJ, et al.: Definitive radiotherapy for squamous cell carcinoma of the base of tongue. Am J Clin Oncol 29 (1): 32-9, 2006.  [PUBMED Abstract]

  11. Al-Kourainy K, Kish J, Ensley J, et al.: Achievement of superior survival for histologically negative versus histologically positive clinically complete responders to cisplatin combination in patients with locally advanced head and neck cancer. Cancer 59 (2): 233-8, 1987.  [PUBMED Abstract]

  12. Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and neck cancer. Semin Oncol 21 (3): 349-58, 1994.  [PUBMED Abstract]

  13. Ensley J, Crissman J, Kish J, et al.: The impact of conventional morphologic analysis on response rates and survival in patients with advanced head and neck cancers treated initially with cisplatin-containing combination chemotherapy. Cancer 57 (4): 711-7, 1986.  [PUBMED Abstract]

  14. Pfister DG, Harrison LB, Strong EW, et al.: Organ-function preservation in advanced oropharynx cancer: results with induction chemotherapy and radiation. J Clin Oncol 13 (3): 671-80, 1995.  [PUBMED Abstract]

  15. Dimery IW, Hong WK: Overview of combined modality therapies for head and neck cancer. J Natl Cancer Inst 85 (2): 95-111, 1993.  [PUBMED Abstract]

  16. Al-Sarraf M, Pajak TF, Marcial VA, et al.: Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer 59 (2): 259-65, 1987.  [PUBMED Abstract]

  17. Bachaud JM, David JM, Boussin G, et al.: Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 20 (2): 243-6, 1991.  [PUBMED Abstract]

  18. Merlano M, Corvo R, Margarino G, et al.: Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck. The final report of a randomized trial. Cancer 67 (4): 915-21, 1991.  [PUBMED Abstract]

  19. Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 12 (12): 2648-53, 1994.  [PUBMED Abstract]

  20. Merlano M, Benasso M, Corvò R, et al.: Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88 (9): 583-9, 1996.  [PUBMED Abstract]

  21. Jeremic B, Shibamoto Y, Stanisavljevic B, et al.: Radiation therapy alone or with concurrent low-dose daily either cisplatin or carboplatin in locally advanced unresectable squamous cell carcinoma of the head and neck: a prospective randomized trial. Radiother Oncol 43 (1): 29-37, 1997.  [PUBMED Abstract]

  22. Jeremic B, Shibamoto Y, Milicic B, et al.: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 18 (7): 1458-64, 2000.  [PUBMED Abstract]

  23. Langer CJ, Harris J, Horwitz EM, et al.: Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Protocol 9911. J Clin Oncol 25 (30): 4800-5, 2007.  [PUBMED Abstract]

  24. Vermorken JB, Remenar E, van Herpen C, et al.: Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357 (17): 1695-704, 2007.  [PUBMED Abstract]

  25. Posner MR, Hershock DM, Blajman CR, et al.: Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357 (17): 1705-15, 2007.  [PUBMED Abstract]

  26. Taylor SG 4th, Murthy AK, Vannetzel JM, et al.: Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 12 (2): 385-95, 1994.  [PUBMED Abstract]

  27. Cox JD, Pajak TF, Marcial VA, et al.: Dose-response for local control with hyperfractionated radiation therapy in advanced carcinomas of the upper aerodigestive tracts: preliminary report of radiation therapy oncology group protocol 83-13. Int J Radiat Oncol Biol Phys 18 (3): 515-21, 1990.  [PUBMED Abstract]