Sequential chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracilin patients with locally advanced head and neck cancer

The purpose of this phase II trial was to evaluate the toxicity of a sequen tial chemoradiotherapy approach using docetaxel, cisplatin, and 5-fluoroura cil (5-FU) (DCF) with granulocyte colony-stimulating factor support in prev iously untreated patients with locally advanced head and neck cancer (HNC). Secondary endpoints included preliminary assessment of response. Patients with locally advanced HNC, a World Health Organization performance status 0 to 2, and no prior history of chemotherapy or radiotherapy were included. Treatment consisted of docetaxel 80 mg/m(2) (1-hour infusion) on day 1, cis platin 40 mg/m(2) (1-hour infusion) on days 2 and 3, and 5-fluorouracil 1,0 00 mg/m(2) (24-hour continuous infusion), on days 1 to 3, repeated every 28 days for a maximum of 4 cycles per patient. All patients received granuloc yte colony stimulating factors subcutaneously between days 4 and 9. Radiati on therapy (RT) to the primary tumor site and neck lymph nodes was planned within 5 weeks of the last cycle of chemotherapy. The primary tumor site re ceived 60 to 70 Gy. Twenty patients (median age 56 years, range: 40-72 year s) received a total of 60 cycles of DCF. The median number of cycles was 3 (range: 1-4 cycles). All patients were evaluable for toxicity and response, The most common acute nonhematologic toxicities from DCF induction chemoth erapy included alopecia, mucositis, peripheral sensory neuropathy, onycholy sis, and asthenia. Febrile neutropenia developed in two patients and grade IV diarrhea in one patient. There were no treatment-related deaths. The ove rall response rate (RR) after DCF induction chemotherapy was 90% (95% confi dence interval [CI]: 76.8-103.1%). After the completion of RT, the overall RR was 95% with a complete response rate of 73% (95% CI: 49.9-90.1%). Organ preservation was achieved in eight patients with laryngeal cancer and one patient with base of tongue involvement. After a median follow-up of 36 mon ths (range: 5-43 months) the median disease-free and overall survival have not been reached yet. The 1- and 2-year survival rates were 85% and 60%, re spectively. Sequential chemoradiotherapy with DCF and growth factor support is feasible and very active, with durable responses in patients with local ly advanced head and neck cancer. Further evaluation of this modality is ju stified in the context of a clinical trial.