Concurrent chemoradiation in locally advanced head and neck cancers: A comparison of weekly paclitaxel with cisplatin-based regimen

Abstract

17032 Background: Concurrent cisplatin-based chemoradiation is the standard of care for patients with unresectable locally advanced squamous cell carcinoma of head and neck (LA-SCCHN) with 5-year locoregional control rates between 35–70%. Taxane-based chemotherapies might improve locoregional control as has been shown in phase I and II trials. This retrospective analysis compares the outcome and toxicity of weekly paclitaxel with weekly cisplatin-based concurrent chemoradiation in LA-SCCHN. Methods: 107 patients of unresectable stage III, IVA and IVB cancers of oropharynx, hypopharynx and larynx were retrospectively analyzed for outcome and toxicity. A retrospective chart review was used to create a data base of clinical and pathologic characteristics of these patients using Microsoft Excel. 58 patients received concurrent weekly paclitaxel (30 mg/m2) and 49 patients were administered weekly cisplatin (40 mg/m2) during radiation therapy with conventional fractionation and curative intention. Results: The median duration of follow up was 12 months in each group (range 3–53 months). In the paclitaxel arm, 43 (74.13%) patients remained alive and disease-free whereas in the cisplatin arm, 33 (67.34%) patients were alive disease-free. This difference was not statistically significant (p=0.34). In the paclitaxel group, among the patients completing radiation in 47 or less days, 26 (81.25%) were alive and disease free in comparison with 17 (65.38%) in those completing radiation in longer than 47 days (odds ratio = 2.29, p=0.16). In the cisplatin arm, alive disease-free status was seen in 18 (67.34%) patients completing radiation in 47 days or less and 15 (65.21%) in those taking longer than 47 days to complete radiation therapy (odds ratio=1.2, p=0.76). The projected mean locoregional relapse free survival in Paclitaxel arm was 33.42 months, and 32.18 months in the cisplatin arm (p=0.73). The 2-year locoregional relapse free survival was 60% in the Paclitaxel arm and 52% in the Cisplatin arm. Conclusion: At 12 months median follow up, weekly paclitaxel-based concurrent chemoradiation regimen provides no additional efficacy and tolerability benefits over and above those provided by weekly cisplatin. No significant financial relationships to disclose.