PREOPERATIVE CHEMORADIATION COUPLED WITH AGGRESSIVE RESECTION AS NEEDED ENSURES NEAR-TOTAL CONTROL IN ADVANCED HEAD AND NECK-CANCER

BACKGROUND: Preoperative chemotherapy or chemoradiation protocols are generally associated with high clinical response rates, but limited pa thologic responses for large primary tumors. We have initiated a prosp ective phase II study of weekly paclitaxel 60 mg/M-2, and carboplatin (AUC of 1) plus concurrent fractionated external beam radiation (45 Gy ) followed by organ-preserving (or function restorative) surgery when applicable to maximize local-regional tumor control. PATIENTS AND METH ODS: Operable patients staged by triple endoscopy received a percutane ous endoscopic gastrostomy and vigorous dental and nutritional support during therapy. Weekly paclitaxel 60 mg/M-2, carboplatin (AUC of 1), and radiation 45 Gy were given with rebiopsy of the primary site at 5 weeks. Patients with positive biopsy had definitive surgery in 4 to 5 weeks. Patients with negative biopsy-results received 3 additional wee ks of radiation, to a total dose of 72 Gy plus carboplatin and paclita xel. RESULTS: The 35 patients were 29 men and 6 women, aged 40 to 71 y ears, with stage III (12) or stage IV (23) cancer. The site of the can cer was oral cavity, 10; base of tongue, 3; oropharynx, 3; hypopharynx , 4; larynx, 12 (glottic, 6; supraglottic, 6), unknown primary, 2; oth er, nasal cavity, 1. Of 34 evaluable patients, 16 (47%) had a complete clinical response (CR) and 18 (53%) had a partial response (PR); tota l clinical response rate was 100%. A pathologic CR at the primary site occurred in 23 of 34 patients (68%; 2 had an unknown primary) who wen t on to completion radiation at 67 to 72 Gy. After induction chemoradi ation 21 patients with N1-3 nodes had neck dissection; 6 (31%) had pos itive nodes. Twelve patients had residual cancer at the primary site a t time of rebiopsy: mandible, 4; maxilla, 1; base of tongue, 2; larynx , 4; floor of mouth, 1; and nasal cavity, 1. All were resected with fu nction-preserving reconstruction. At median follow-up of >12 months, p rogression-free and overall survivals were 71% and 83%, respectively. CONCLUSION: Preoperative treatment with paclitaxel, carboplatin, and r adiation is associated with high CR at the primary site and a high lev el of organ preservation or functional restoration if ablation is done . (C) 1997 by Excerpta Medica, Inc.