Induction chemotherapy with cisplatin plus weekly paclitaxel followed by chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck

Abstract

The paclitaxel-cisplatin is a non-infusional alternative for induction chemotherapy (IC) for LASCCHN based on phase-II trials. Here, we describe our institutional experience with this combination in Southern Brazil. Methods: Thirty-three consecutive patients with unresectable LASCCHN were selected between April/2012 and June/2014. They received weekly paclitaxel 80mg/m2 on days 1, 8, 15 and cisplatin 75mg/m2 on day 1 for three cycles followed by chemoradiotherapy (CRT) with cisplatin at standard dose. Overall response, toxicity, progression free survival (PFS) and overall survival (OS) were evaluated. Results: The median follow-up was 25.5 months. Median age was 58.6 years and 96% had PS 1. Most patients presented with bulky disease at stages IVA and IVB (60.6% and 21.2%, respectively). Concerning primary site of tumor, 33.3% were oropharingeal tumors, 27.3% larynx tumors and 33.3% oral cavity tumors. The majority of patients had both smoking and alcohol abuse records. Twenty-eight patients (84.8%) at the time of diagnosis had a BMI <25. Twenty-seven patients (81.8%) completed the planned treatment and three patients (9%) underwent exclusive radiotherapy after IC. All patients were evaluated for response; 75.7% presented complete response and 21.2% presented partial response. Severe toxicity (grades 3-5) for asthenia, neutropenia, anemia and thrombocytopenia were observed in 6.1%, 9.1%, 6.1% and 3% of patients, respectively. One treatment-related death was associated with febrile neutropenia. The 2- and 3-year PFS rates were 63.3% and 68.4%, respectively; 2- and 3-year OS rates were 62.3.5% and 50.6%. Conclusions: Our results corroborate previous observations that IC (paclitaxel-cisplatin) is a well-tolerated and highly active regimen for the treatment of patients with LASSHNC, being associated with acceptable toxicity, good locoregional control and survival rates. This may be a good treatment option for patients in developing countries.

Keywords

• Head and Neck Cancer
• Induction Chemotherapy
• Chemoradiation Therapy
• Squamous Cell Carcinoma.
• Câncer de Cabeça e Pescoço
• Quimioterapia de Indução
• Quimiorradioterapia
• Carcinoma de Células Escamosas.