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.

RESUMO

O esquema paclitaxel-cisplatina é uma alternativa não-infusional como quimioterapia de indução (QI) para carcinomas escamosos de cabeça e pescoço localmente avançados, baseado em estudos de fase II. Descrevemos, aqui, nossa experiência institucional com esta modalidade de tratamento. Métodos: Trinta e três pacientes consecutivos diagnosticados com carcinoma escamoso de cabeça e pescoço localmente avançado, não-ressecável, foram selecionados entre abril/2012 e junho/2014. Receberam paclitaxel 80 mg/m² nos dias 1, 8 e 15 + cisplatina 75 mg/m² no D1 por três ciclos, seguidos por quimiorradioterapia com cisplatina em dose padrão. Foram avaliadas resposta global, toxicidade, sobrevida livre de progressão (SLP) e sobrevida global (SG). Resultados: A mediana de seguimento foi de 25,5 meses. A mediana de idade foi de 58,6 anos e 96% dos pacientes apresentaram PS 1. A maioria dos pacientes apresentou doença volumosa em estágios IVA e IVB (60,6% e 21,2%, respectivamente). Quanto ao sítio primário, 33,3% eram tumores orofaríngeos, 27,3% tumores de laringe e 33,3% tumores de cavidade oral. Vinte e oito pacientes (84,8%) apresentaram IMC <25 ao diagnóstico. Vinte e sete pacientes (81,8%) completaram o tratamento planejado e três pacientes (9%) foram submetidos à radioterapia exclusiva após QI. Todos os pacientes foram avaliados quanto à resposta; 75,7% apresentaram resposta completa e 21,2% apresentaram resposta parcial. Foi observada toxicidade grave (G3-5) para astenia, neutropenia, anemia e trombocitopenia em 6,1%, 9,1%, 6,1% e 3% dos pacientes, respectivamente. Um óbito relacionado ao tratamento foi atribuído à neutropenia febril. As taxas de SLP para 2 e 3 anos foram de 63,3% e 68,4%, respectivamente; as taxas de SG para 2 e 3 anos foram de 62,3,5% e 50,6%. Conclusões: Nossos resultados corroboram observações prévias de que QI (paclitaxel-cisplatina) é um regime bem tolerado e altamente ativo para o tratamento de pacientes com carcinomas escamosos de cabeça e pescoço localmente avançados, estando associado a toxicidade tolerável, controle locorregional e taxas de sobrevida satisfatórios. Esta pode ser uma opção de tratamento adequada a ser considerada para pacientes em países em desenvolvimento.

Keywords:

Head and Neck Cancer - Induction Chemotherapy - Chemoradiation Therapy - Squamous Cell Carcinoma.

Descritores:

Câncer de Cabeça e Pescoço - Quimioterapia de Indução - Quimiorradioterapia - Carcinoma de Células Escamosas.

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