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Cisplatin, fluorouracil, and leucovorin induction chemotherapy followed by concurrent cisplatin chemoradiotherapy for organ preservation and cure in patients with advanced head and neck cancer: long-term follow-up.

AbstractPURPOSE:
The poor functional outcome in patients with advanced head and neck squamous cell carcinoma (HNSCC) with surgery and radiation has led to alternative approaches to advanced disease. We conducted a phase II study of induction chemotherapy followed by concurrent chemoradiotherapy for organ preservation in patients with advanced resectable and unresectable (nasopharyngeal) tumors.
PATIENTS AND METHODS:
Forty-two patients with stage III to IV resectable HNSCC and nasopharyngeal tumors received induction chemotherapy with two courses of cisplatin (20 mg/m2/d continuous infusion [CI]), fluorouracil (800 mg/m2/d CI), and leucovorin (500 mg/m2/d CI; PFL) for 4 days followed by concurrent therapy with cisplatin (100 mg/m2/d on days 1 and 22) and approximately 70 Gy of external-beam radiotherapy.
RESULTS:
Response to induction chemotherapy included partial response rate of 52% and complete response rate of 24%. The most common grade 3 or 4 toxicity was neutropenia (59%). After cisplatin chemoradiotherapy the complete response rate was 67%. Toxicities of cisplatin chemoradiotherapy consisted of grade 3 or 4 mucositis (79%) and neutropenia (51%). At a median follow-up of 71.5 months, 43% of the patients are still alive and disease-free. The 5-year progression-free survival (PFS) rate was 60%, and the 2- and 5-year overall survival (OS) rates were 67% and 52%, respectively. Three patients died of second primaries. Late complications of treatment included xerostomia and hoarseness. One patient had persistent dysphagia and required laser epiglotectomy 108 months after treatment.
CONCLUSION:
Induction chemotherapy with PFL followed by concurrent cisplatin chemoradiotherapy is well tolerated and results in a good likelihood of organ preservation and excellent PFS and OS.
AuthorsA Psyrri, M Kwong, S DiStasio, L Lekakis, M Kassar, C Sasaki, L D Wilson, B G Haffty, Y H Son, D A Ross, P M Weinberger, G G Chung, D Zelterman, B A Burtness, D L Cooper
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 22 Issue 15 Pg. 3061-9 (Aug 1 2004) ISSN: 0732-183X [Print] United States
PMID15284256 (Publication Type: Clinical Trial, Clinical Trial, Phase II, Journal Article)
CopyrightCopyright 2004 American Society of Clinical Onocology
Chemical References
  • Antineoplastic Agents
  • Cisplatin
  • Leucovorin
  • Fluorouracil
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents (administration & dosage)
  • Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
  • Brachytherapy
  • Carcinoma, Squamous Cell (drug therapy, mortality, radiotherapy, therapy)
  • Cisplatin (administration & dosage, adverse effects, therapeutic use)
  • Combined Modality Therapy
  • Drug Administration Schedule
  • Female
  • Fluorouracil (adverse effects, therapeutic use)
  • Follow-Up Studies
  • Head and Neck Neoplasms (drug therapy, mortality, radiotherapy, therapy)
  • Humans
  • Leucovorin (adverse effects, therapeutic use)
  • Male
  • Middle Aged
  • Quality of Life
  • Remission Induction
  • Survival Rate
  • Treatment Outcome

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