Cancer Res Treat.  2007 Sep;39(3):93-98.

The Efficacy of an Induction Chemotherapy Combination with Docetaxel, Cisplatin, and 5-FU Followed by Concurrent Chemoradiotherapy in Advanced Head and Neck Cancer

• Ahn JS
• Cho SH
• Kim OK
• Lee JK
• Yang DH
• Kim YK
• Lee JJ
• Lim SC
• Kim HJ
• Chung WK
• Chung IJ

Abstract

PURPOSE: This study was performed to determine the feasibility and safety of the use of induction chemotherapy combined with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiation therapy for locally advanced squamous cell carcinoma of the head and neck (SCCHN).
MATERIALS AND METHODS
The patients, that were initially not treated for locally advanced SCCHN, underwent three cycles of induction chemotherapy every 3 weeks at a dose of 70 mg/m2 docetaxel D1, 75 mg/m2 cisplatin D1, 1000 mg/m2 5-FU D1-4, and subsequently received concurrent chemoradiation therapy.
RESULTS
Forty-nine patients were enrolled in this study and forty-three of the patients completed the treatment. The median duration of follow-up was 18 months (range, 6~39 months). All of the patients had stage III (26.5%) or IV (73.5%) squamous cell carcinoma. After sequential therapy, a complete response and partial response was seen in 28 (65.2%) and 13 (30.2%) patients, respectively. The overall response rate was 95.4%. Overall survival and progression-free survival (PFS) at 2 years were 88.7% and 69.7%, respectively. Grade 3~4 neutropenia occurred in 42.2% of the patients and grade 4 thrombocytopenia in 1 cycle (0.7%). Two patients (4.1%) died during the induction chemotherapy due to pneumonia and a subdural hemorrhage, respectively. The group of patients over 65 years of age showed a significant lower dose intensity than that of patients under 65 years of age, but PFS was not significantly different between two groups (p=0.105).
CONCLUSION
TPF induction chemotherapy followed by concurrent chemoradiotherapy showed a high level of CR and moderate treatment-induced toxicity. Adequate dose modification in elderly patients should be considered to maintain efficacy and avoid treatment-related toxicity.

Keyword

Head and neck neoplasms; Radiotherapy; Docetaxel; Combination chemotherapy

MeSH Terms

Aged
Carcinoma, Squamous Cell
Chemoradiotherapy*
Cisplatin*
Disease-Free Survival
Drug Therapy, Combination
Fluorouracil*
Follow-Up Studies
Head and Neck Neoplasms*
Head*
Hematoma, Subdural
Humans
Induction Chemotherapy*
Neck
Neutropenia
Pneumonia
Radiotherapy
Thrombocytopenia
Cisplatin
Fluorouracil

Figure

• 

  Fig. 1 Progression free survival (PFS) and overall survival (OS) for all patients (n= 42). The 1-year and 2-year OS rate was 93.6% (95% CI 89.3~97.9%) and 88.7% (95% CI 82.4~95.0%), respectively. Progression-free survival (PFS) at 1-year and 2-years was 78.9% (95% CI 72.2~85.6%) and 69.7% (95% CI 61.2~78.2%).

• 

  Fig. 2 Progression-free survival (PFS) according to age; the PFS at 2 years of the group of patients under the age of 65 years was longer than that of the group of patients over the age of 65 years, at 78.5% (95% CI, 68.7~88.3%) and 52.4% (95% CI, 35.0~69.8%), respectively (p=0.105).

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