The effect of induction therapy with carboplatin-paclitaxel and low dose radiotherapy followed by hyperfractionated radiotherapy and intraarterial chemotherapy on advanced cancers of the head and neck

Abstract

15517 Background: The purpose of this study is to evaluate the potential benefits of induction therapy followed by intraarterial cisplatin and hyperfractionated radiation (HYPERRADPLAT) on patients with advanced head and neck tumors. Methods: 20 patients with Stage III-IV squamous cell carcinoma of the head and neck were treated with induction therapy consisting of 2 cycles of carboplatin (AUC 6) and paclitaxel (225 mg/m2) and 0.8 Gy BID on the day of and the day following chemotherapy. Induction therapy was given over 2 cycles separated by 3 weeks (previously described in ASCO 2002 abstract # 921 and 2004 abstract # 5593). Patients were then treated with the HYPERRADPLAT regimen consisting of external beam radiotherapy (74.4–81.6 Gy) delivered in 1.2 Gy BID fractions with intraarterial cisplatin (150 mg/m2) administered when patients had reached 60 Gy. Tumor response, disease free survival, overall survival, and toxicity were assessed for all patients according to NCI CTCAE criteria. Results: Of 20 patients, 9 had tumors of the oropharynx, 9-supralaryngeal, and 2-hypopharyngeal. Fifty percent of patients had T4 tumors and 35% had T3 tumors. Complete tumor response was observed in 80% of patients and 20% had a partial response. Three-year disease free survival was 75% and overall survival was 75%. Locoregional recurrence was noted in 25% of patients and 15% had distant failure. Overall recurrence was noted in 40% of patients with a median time to recurrence of 12 months (range 6–55 months). Median weight loss during treatment was 10% of initial body weight and 13 patients required a feeding tube within 6 months of starting treatment. Grade 3 mucositis was noted in 65% of patients and no patients developed Grade 4 toxicity. Conclusions: Two cycles of carboplatin-paclitaxel induction therapy followed by intraarterial cisplatin and hyperfractionated radiotherapy produces excellent tumor response and reduces distant failure. These results compare favorably with historical controls and produce tolerable toxicity profiles. [Table: see text]