Abstract
Purpose:
Concurrent chemoradiotherapy (CRT) is standard treatment for advanced head and neck cancer. Whether short induction chemotherapy (ICT) provides additional benefit or, in particular, predictive benefit for the response to chemoradiotherapy is an open question. The present study aimed to assess the feasibility, toxicity, and efficacy of induction with docetaxel and platinum salt (TP) and subsequent CRT.
Patients and Methods:
A total of 25 patients with functionally inoperable cancer of the base of the tongue, hypopharynx, or larynx received 1 cycle of docetaxel (75 mg/m², day 1) combined with either cisplatin (30 mg/m², days 1–3; n = 23) or carboplatin (AUC 1.5 days 1–3; n = 2). Responders (n = 22, >30% tumor reduction, graded by endoscopy) and 1 non-responder received CRT (target dose: 69–72 Gy) with cisplatin/paclitaxel, carboplatin/paclitaxel, or cisplatin/docetaxel.
Results:
All patients completed ICT with acceptable toxicity (leukocytopenia grade 4: 8%). The remission rate of the primary tumor was 88% (22/25 patients). There was no need to delay CRT due to toxicity in any case. Each patient received the full radiation dose. Of the patients, 56% received >80% of the chemotherapy. The acute toxicity of CRT was moderate, no grade 4 toxicities occurred, while grade 3 toxicities included the following: infection (39%), dermatitis (13%), leukocytopenia (30%), and thrombocytopenia (4%). The local control rate was 84.6% ± 8.5% and the survival rate was 89.6% ± 7.2% at 12 months. Organ preservation was possible in 22/23 (95%) cases.
Conclusion:
Short induction with a TP regimen and subsequent CRT with a taxan is feasible and associated with an encouraging local control rate.
Zusammenfassung
Ziel:
Die simultane Radiochemotherapie (CRT) ist Standard bei fortgeschrittenen Kopf-Hals-Tumoren. Offen ist der Stellenwert einer Kurzzeitinduktionschemotherapie (ICT), insbesondere deren prädiktive Bedeutung für das Ansprechen der Radiochemotherapie. In der Studie werden Durchführbarkeit, Toxizität und Effektivität einer Induktionschemotherapie mit Docetaxel und einem Platinsalz einschließlich der folgenden RCT berichtet.
Patienten und Methode:
25 Patienten mit einem nicht funktionserhaltend operablen Zungengrund-, Hypopharynx- und Larynxkarzinom erhielten einen Zyklus Docetaxel (75 mg/m2, d1) und Cisplatin (30 mg/m2 d-1–3) (n = 23) oder Carboplatin (AUC 1,5 d1-3) (n = 2). Responder (n = 22, mehr als 30% Rückbildung endoskopisch) und ein Non-Responder erhielten nachfolgend eine RCT (Zieldosis: 69–72 Gy) mit Cisplatin/Paclitaxel rsp. Carboplatin/Paclitaxel oder Cisplatin/Docetaxel.
Ergebnisse:
Die Induktionstherapie konnte bei allen Patienten mit akzeptabler Toxizität (Leukozytopenie Grad 4: 8%) durchgeführt werden. Die Remissionsrate des Primärtumors betrug 88% (22/25 Pat). Die Radiochemotherapie wurde in keinem Fall toxizitätsbedingt verzögert. Die Radiotherapiedosis wurde vollständig gegeben. 56% der Patienten erhielten >80% der geplanten Chemotherapie. Die Akuttoxizität der RCT war moderat, keine Grad-4-Toxizität; Grad-3-Toxizitäten: Infektion (39%), Dermatitis (13%), Leukozytopenie (30%), Thrombozytopenie (4%). Nach 12 Monaten lag die Lokalkontrolle bei 84,6% ± 8,5%, das Gesamtüberleben 89,6% ± 7,2%. Die Organerhaltquote lag bei 95% (22/23).
Schlussfolgerung:
Die Kurzinduktion mit TP und die nachfolgende CRT mit einem Taxan sind durchführbar und führten zu einer ermutigenden Tumorkontrolle.
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Semrau, S., Waldfahrer, F., Lell, M. et al. Feasibility, Toxicity, and Efficacy of Short Induction Chemotherapy of Docetaxel Plus Cisplatin or Carboplatin (TP) Followed by Concurrent Chemoradio therapy for Organ Preservation in Advanced Cancer of the Hypopharynx, Larynx, and Base of Tongue. Strahlenther Onkol 187, 15–22 (2011). https://doi.org/10.1007/s00066-010-2178-2
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DOI: https://doi.org/10.1007/s00066-010-2178-2