Divya Arora, Presenter: Nothing to Disclose

Alan Gowan, Abstract Co-Author: Nothing to Disclose

Divya Patel, Abstract Co-Author: Nothing to Disclose

Kuang-Wei Chang MD, Abstract Co-Author: Nothing to Disclose

Niloyjyoti Deb MD, Abstract Co-Author: Nothing to Disclose

Mehul Patel, Abstract Co-Author: Nothing to Disclose

Induction chemotherapy with cisplatin-docetaxel followed by concurrent chemoradiation for locally advanced head and neck cancerPurpose/Objective(s):Induction chemotherapy regimen with docetaxel, cisplatin and 5-flourouracil (TPF) for locally advanced head and neck squamous cell cancer (HNSCC) has shown an overall survival benefit when compared with cisplatin and 5-flourouracil (PF). The TAX 323 and TAX 324 studies comparing these treatment groups demonstrated a median progression free survival of 11 versus 8 months and 36 versus 13 months, respectively.There are limited data on outcomes from other induction regimens such as Cisplatin and Taxotere (TP) for locally advanced HNSCC. TPF induction chemotherapy has shown an increased incidence of grade 3-4 neutropenia (83% in TAX3 24). The purpose of this study was to determine overall survival, progression-free survival, and toxicities of patients treated with TP induction chemotherapy followed by concurrent chemotherapy and radiation.Materials/Methods:We conducted a retrospective, IRB approved review of patients treated for locally advanced HNSCC between August 2009 and August 2013. Using the institution tumor registry, 203 patients with stage III or IV HNSCC were identified; 19 (9.3%) patients received induction chemotherapy with TP and were included in the analyses. Subsequently, these patients received chemotherapy (weekly cisplatin or carboplatin) concurrently with fractionated external beam radiotherapy of approximately 70 Gy. Two (10.5%) of the 19 patients were unable to receive radiation due to progression of disease. Patients received between 1 and 4 cycles of induction chemotherapy. Overall survival and progression free survival functions were generated using the Kaplan-Meier method.Results:The primary indication for induction chemotherapy was due to locally advanced disease with a “large burden” of disease (94.7%). Follow up duration ranged from 2.8-45.6 months (median: 11.9 months). One year overall survival was 65.6%. Median survival was not reached. Locoregional failure rate was 42.1%. Median progression free survival was 19.8 months. One year progression free survival was 54.4%. Grade 3 or higher toxicities included mucositis (15.8%), dysphagia (57.9%), anemia (31.5%), and neutropenia (21%). Long term toxicities were rare and consisted mainly of xerostomia.Conclusion:In our study, progression free survival with induction TP was 19.8 months which is consistent with results from large randomized studies of TAX 323 and TAX 324. However, grade 3 or higher neutropenia was observed in 31.5% of our study patients, compared to 76.9-83% with TPF in the large studies. While this is a small study of induction TP in a frail population, the results are promising and may warrant further study.

Arora, D, Gowan, A, Patel, D, Chang, K, Deb, N, Patel, M, Induction Chemotherapy with Cisplatin-docetaxel followed by Concurrent Chemoradiation for Locally Advanced Head and Neck Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14042407.html