© 2007 European Society for Medical Oncology
head and neck cancer |
Long-term outcomes with concurrent carboplatin, paclitaxel and radiation therapy for locally advanced, inoperable head and neck cancer
1 Division of Hematology/Oncology, Department of Medicine
2 Department of Radiation Oncology
3 Department of Otolaryngology
4 Department of Biostatistics, University of Pittsburgh and Head and Neck Cancer Program of the University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
* Correspondence to: Dr A. Argiris, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh and Head and Neck Cancer Program of the University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232, USA. Tel: +412-648-6575; Fax: +412-648-6579; E-mail: argirisae{at}upmc.edu
Background: Our goal was to evaluate long-term efficacy outcomes of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with carboplatin, paclitaxel (Taxol) and radiotherapy.
Patients and methods: We conducted a phase II trial in inoperable patients with locally advanced SCCHN. Carboplatin 100 mg/m2 and paclitaxel 40 mg/m2 were administered i.v. once a week during external beam radiation therapy (180 cGy per fraction) for 6–7 weeks. Interstitial brachytherapy was used as a boost in selected patients with primary malignancies of the oral cavity and the oropharynx.
Results: Fifty-five patients were enrolled. Fifty-two patients (95%) had stage IV and 51 (93%) had technically unresectable disease; 62% had an oropharyngeal primary site. Twenty-one patients underwent brachytherapy boost. Grade 3 or 4 mucositis occurred in 30% of patients. One death occurred during treatment that was related to complications of gastrostomy tube placement. Forty of 50 assessable patients (80%) had an objective response, with a complete response rate of 52%. With a median follow-up of 69 months for surviving patients, the 5-year progression-free survival was 36% and the 5-year overall survival was 35%. Two of the 18 long-term survivors of >50 months were gastrostomy tube feeding dependent. Patients undergoing brachytherapy boost (n = 21) had similar outcomes compared with the rest of the patients. In multivariate analysis, baseline hemoglobin levels and N stage were predictive of survival.
Conclusion: Treatment with concurrent carboplatin, paclitaxel and radiation is safe and offers curative potential for poor prognosis patients with locally advanced SCCHN.
Key words: brachytherapy, carboplatin, head and neck cancer, paclitaxel, radiation
Received for publication September 25, 2006. Revision received February 7, 2007. Accepted for publication February 8, 2007.
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