Concomitant infusional paclitaxel and fluorouracil, oral hydroxyurea, and hyperfractionated radiation for locally advanced squamous head and neck cancer

Purpose: To improve local disease control and survival with organ preservat ion, we conducted ct phase II multi-institutional trial with a concomitant taxane-based chemotherapy and hyperfractionated radiation regimen. Patients and Methods: Sixty-four patients with locally advanced squamous ca ncers (stage IV, 98%; N2/3, 81%) were treated on fin intensive regimen cons isting of 5-day (120-hour) infusions of paclitaxel 120 mg/m(2)/d) and fluor ouracil (600 mg/m2/d), oral hydroxyurea 500 mg every 12 hours for 11 doses, and radiation 1.5 Gy bid (T-FH2X). Chemoradiation was administered concomi tantly on days 1 to 5 of each 14-day cycle. A full treatment course consist ed of five cycles during a 10-week period to a total radiation dose of 72 t o 75 Gy. Results: The median follow-up for the group is 34 months. At 3 years, progr ession-free survival is 63%, locoregional control is 86%, and systemic cont rol is 79%; overall survival is 60%. Seventeen patients died of recurrent c ancer, two died of second primary cancers, and four died of other causes. S ide effects observed include anemia (22% required transfusion), leucopenia (34%, grade 3 to 4), and mucositis (84%, grade 3 to 4). Organ preservation principles were maintained. At 1 year posttreatment, 61% of patients had re vere xerostomia and 47% had compromised swallowing. There was little distur bance of speech quality in 97% of patients at the same follow-up point. Conclusion T-FH2X is a highly active and tolerable concomitant chemotherapy and hyperfractionated radiation regimen that induces sustained local tumor control and holds promise for improved survival with organ preservation in high-risk patients. Identification of less toxic therapy and improved dist ant disease control are needed. T-FH2X should be tested in a randomized tri al and compared with a less intensive concomitant regimen that uses once-da ily radiation fractionation. (C) 2001 by American Society of Clinical Oncol ogy.