title: Preoperative chemoradiation coupled with aggressive resection as needed ensures near total control in advanced head and neck cancer.
abstract: BACKGROUND
  Preoperative chemotherapy or chemoradiation protocols are generally associated with high clinical response rates, but limited pathologic responses for large primary tumors. We have initiated a prospective phase II study of weekly paclitaxel 60 mg/M2, 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.
  
  
  METHODS
  Operable patients staged by triple endoscopy received a percutaneous endoscopic gastrostomy and vigorous dental and nutritional support during therapy. Weekly paclitaxel 60 mg/M2, 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 weeks of radiation, to a total dose of 72 Gy plus carboplatin and paclitaxel.
  
  
  RESULTS
  The 35 patients were 29 men and 6 women, aged 40 to 71 years, with stage III (12) or stage IV (23) cancer. The site of the cancer was oral cavity, 10; base of tongue, 3; oropharynx, 3; hypopharynx, 4; larynx, 12 (glottic, 6; supraglottic, 6), unknown primary, 2; other, nasal cavity, 1. Of 34 evaluable patients, 16 (47%) had a complete clinical response (CR) and 18 (53%) had a partial response (PR); total 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 went on to completion radiation at 67 to 72 Gy. After induction chemoradiation 21 patients with N1-3 nodes had neck dissection; 6 (31%) had positive nodes. Twelve patients had residual cancer at the primary site at 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 function-preserving reconstruction. At median follow-up of >12 months, progression-free and overall survivals were 71% and 83%, respectively.
  
  
  CONCLUSIONS
  Preoperative treatment with paclitaxel, carboplatin, and radiation is associated with high CR at the primary site and a high level of organ preservation or functional restoration if ablation is done.
authors.affiliation: Brown University Oncology Group of Rhode Island, Providence 02908, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Wanebo
authors.forename: P
authors.initials: P
authors.lastname: Chougule
authors.forename: W L
authors.initials: WL
authors.lastname: Akerley
authors.forename: R J
authors.initials: RJ
authors.lastname: Koness
authors.forename: R
authors.initials: R
authors.lastname: McRae
authors.forename: P
authors.initials: P
authors.lastname: Nigri
authors.forename: L
authors.initials: L
authors.lastname: Leone
authors.forename: N
authors.initials: N
authors.lastname: Ready
authors.forename: H
authors.initials: H
authors.lastname: Safran
authors.forename: B
authors.initials: B
authors.lastname: Webber
authors.forename: B
authors.initials: B
authors.lastname: Cole
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011300:Preoperative Care; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D016190:Carboplatin; D017239:Paclitaxel