This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Psyrri, A. Articles by Cooper, D.L. Search for Related Content PubMed PubMed Citation Articles by Psyrri, A. Articles by Cooper, D.L. Social Bookmarking                            What's this?

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

From the Departments of Medical Oncology, Therapeutic Radiology and Otolaryngology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT

Address reprint requests to Amanda Psyrri, MD, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520-8032; e-mail: diamando.psyrri{at}yale.edu

PURPOSE: 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.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Raykher, L. Correa, L. Russo, P. Brown, N. Lee, D. Pfister, H. Gerdes, J. Shah, D. Kraus, M. Schattner, et al. The Role of Pretreatment Percutaneous Endoscopic Gastrostomy in Facilitating Therapy of Head and Neck Cancer and Optimizing the Body Mass Index of the Obese Patient JPEN J Parenter Enteral Nutr, July 1, 2009; 33(4): 404 - 410. [Abstract] [Full Text] [PDF]

				S. JO, A. JUHASZ, K. ZHANG, C. RUEL, S. LOERA, S. P. WILCZYNSKI, Y. YEN, X. LIU, J. ELLENHORN, D. LIM, et al. Human Papillomavirus Infection as a Prognostic Factor in Oropharyngeal Squamous Cell Carcinomas Treated in a Prospective Phase II Clinical Trial Anticancer Res, May 1, 2009; 29(5): 1467 - 1474. [Abstract] [Full Text] [PDF]

				K. UEDA, S. INOUE, Y. ZHANG, T. KUTSUNA, S. INOUE, K. NOTO, N. ARAI, and M. NOGUCHI Heparin Induces Apoptosis through Suppression of AKt in Oral Squamous Cell Carcinoma Cells Anticancer Res, April 1, 2009; 29(4): 1079 - 1088. [Abstract] [Full Text] [PDF]

				S.-F. Yang, W.-E. Yang, H.-R. Chang, S.-C. Chu, and Y.-S. Hsieh Luteolin Induces Apoptosis in Oral Squamous Cancer Cells Journal of Dental Research, April 1, 2008; 87(4): 401 - 406. [Abstract] [Full Text] [PDF]

				A. Raykher, L. Russo, M. Schattner, L. Schwartz, B. Scott, and M. Shike Enteral Nutrition Support of Head and Neck Cancer Patients Nutr Clin Pract, February 1, 2007; 22(1): 68 - 73. [Abstract] [Full Text] [PDF]

				D. J. Adelstein and M. LeBlanc Does Induction Chemotherapy Have a Role in the Management of Locoregionally Advanced Squamous Cell Head and Neck Cancer? J. Clin. Oncol., June 10, 2006; 24(17): 2624 - 2628. [Abstract] [Full Text] [PDF]

				M. R. Posner Paradigm Shift in the Treatment of Head and Neck Cancer: The Role of Neoadjuvant Chemotherapy Oncologist, October 1, 2005; 10(suppl_3): 11 - 19. [Abstract] [Full Text] [PDF]

				A. A. Forastiere Is There a New Role for Induction Chemotherapy in the Treatment of Head and Neck Cancer? J Natl Cancer Inst, November 17, 2004; 96(22): 1647 - 1649. [Full Text] [PDF]