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Annals of Oncology 14:367-372, 2003
© 2003 European Society for Medical Oncology

Original Paper

Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer

L. Licitra1,+, L. D. Locati1, R. Cavina1, I. Garassino1, F. Mattavelli2, N. Pizzi2, P. Quattrone3, P. Valagussa4, L. Gianni1, G. Bonadonna1, C. L. Solero5 and G. Cantu2

1 Unit of Medical Oncology A, 2 Maxillofacial Surgery Department, 3 Pathology Department and 4 Operations Office, Istituto Nazionale Tumori, Milan; 5 Second Division of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy

Received 26 March 2002; revised 10 October 2002; accepted 22 November 2002

Background:

To study prospectively the activity of primary chemotherapy with cisplatin, fluorouracil and leucovorin (PFL) in patients with paranasal cancer receiving surgery and postoperative radiotherapy.

Patients and methods:

Forty-nine patients, previously untreated, with resectable paranasal carcinoma were enrolled. PFL (leucovorin 250 mg/m2/day for 5 days as a 120 h continuous infusion (c.i.), 5-fluorouracil 800 mg/m2/day from day 2 as a 96 h c.i. and cisplatin 100 mg/m2 day 2 q 3 weeks) was planned for five courses.

Results:

Thirty-two patients (65%) completed three or more chemotherapy courses. Two deaths from thrombotic events were observed after the first cycle. Eight cardiac toxicities were recorded during chemotherapy causing treatment discontinuation. Objective response to PFL was observed in 21 patients [43%; 95% confidence interval (CI) 29% to 58%], including four complete responses (CRs) (8%; 95% CI 2% to 20%) and 17 partial responses (PRs) (35%). Pathological complete remission (pCR) was achieved in eight of 49 patients (16%). At 3 years, overall survival was 69% and event-free survival 57%. Overall and event-free survival in patients achieving pCR is 100%.

Conclusions:

PFL is active in paranasal cancer. Patients who attain a pathological complete remission have a favorable prognosis. Cardiovascular complications represent the limiting toxicity. Primary chemotherapy combined with surgery-sparing treatment approaches deserves further investigation.

Key words: anterior craniofacial resection, paranasal cancer, primary chemotherapy


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