Treatment Outcomes for Radiation Therapy with Concurrent Carboplatin and Paclitaxel for Locally Advanced Head and Neck Cancer

Abstract

<h3>Purpose/Objective(s)</h3> There is a lack of consensus on what is the preferred systemic regimen in combination with radiation therapy for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We report the outcomes of cisplatin-ineligible patients with HNSCC treated with definitive radiation therapy and weekly concurrent carboplatin and paclitaxel at our institution. <h3>Materials/Methods</h3> We included consecutive HNSCC patients treated from 2013 to 2021 that received definitive radiation therapy with weekly carboplatin and paclitaxel for oropharynx, larynx, hypopharynx and unknown primary cancers. We excluded patients who received induction chemotherapy or re-irradiation and patients who had multiple or synchronous primary malignancies. Locoregional control (LRC) and distant control (DC) were estimated using cumulative incidence functions while progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. <h3>Results</h3> Sixty-six patients were identified with median age of 70 years (range 44 – 85). Disease sites included oropharynx (n=44), larynx (n=15), hypopharynx (n=5), and unknown primary cancer (n=2). Thirty-five patients (53%) had HPV+ disease. Thirty-three patients had T3 or 4 disease (50%) and 48 (72.7%) had N2 or 3 disease. Median radiation dose received was 70 Gy and the median doses of carboplatin and paclitaxel were AUC 1 and 40 mg/m². Patients received a median of 7 cycles of chemotherapy. At a median follow up of 22 months (range 0.5 – 83.6), the 2-year rates of LRC, DC, PFS, and OS rates were 90.4%, 93.5%,78% (95% CI: 67% – 90%) and 88% (95% CI: 80% - 97%), respectively. There were 4 locoregional failures, 5 distant metastases, and 11 deaths. However, 9/11 deaths occurred in patients without local or distant recurrence. The majority of these deaths were attributed to other medical causes such as upper gastrointestinal bleeds, severe ulcerative colitis, and myocardial infarction. There was one patient with difficulty breathing due to prominent treatment related mucosal edema, which resulted in sudden expiration. <h3>Conclusion</h3> Radiation therapy with weekly carboplatin and paclitaxel is an option for HNSCC patients who are cisplatin-ineligible. Randomized trials are needed to compare carboplatin and paclitaxel with other systemic regimens for this population.