Induction paclitaxel and carboplatin for patients with head and neck carcinoma - Analysis of 62 patients treated between 1994 and 1999

BACKGROUND, After standard therapy for advanced head and neck carcinoma, 5- year survival rate is less than 50%. Our purpose was to develop a new treat ment for advanced head and neck carcinoma by using preoperative chemotherap y. Long term efficacy and toxicity of induction paclitaxel and carboplatin is reported here. METHODS. Between 1994 and 1999, 62 consecutive patients with newly diagnose d head and neck carcinoma were treated with paclitaxel and carboplatin indu ction chemotherapy. Chemotherapy was administered every 21 days with 3 cour ses of paclitaxel (150-265 mg/m(2)) and carboplatin at a dose calculated us ing the Calvert formula area under the curve of 7.5. Patients who achieved complete or partial response at the primary received definitive radiation t o the primary tumor and hose with lymph node disease received neck dissecti on followed by radiation to the regional lymph nodes. Nonresponders receive d standard resection of primary turner and draining lymph node basin follow ed by radiation. RESULTS. Sixty-two consecutive patients were treated. Seventy-four percent had Stage TV (according to the 5th edition of American Joint Committee on C ancer Staging manual) disease. The median duration of follow-up from initia tion of chemotherapy was 64 weeks (range, 1-272 weeks). Overall complete pl us partial response rate was 41 of 62 (66%). Responses were observed at all anatomic sites: oropharynx 20 of 33 (61%); hypopharynx 8 of 12 [67%); and larynx 13 of 17 (76%). Kaplan-Meier estimates of overall survival (OS), at 230 weeks, were significantly better in Stage IV oropharynx/hypopharynx res ponders than nonresponders (55% vs. 27%; P = 0.04). Of the variables evalua ted in multivariate models, response at the primary tumor and lymph nodes w ere associated with improved disease free survival and OS. Organ preservati on was achieved in 28 of 62 (45%) of patients at all anatomic sires: oropha rynx 39%, hypopharynx 42%, larynx 59%. Seventeen of 28 (61%) patients had t heir primary organ site preserved for a mean duration of 78 weeks (range, 1 3-238 weeks). CONCLUSIONS, Induction paclitaxel and carboplatin was well tolerated. The r esponse rate was encouraging considering most patients were Stage IV. Chemo therapy response identified a group with improved prognosis. Organ preserva tion was possible at all anatomic sites. (C) 2001 American Cancer Society.