Palliation of pelvic and head and neck cancer with paclitaxel and a novel radiotherapy regimen.
OBJECTIVE
In patients with advanced malignancies, local palliation is undertaken if the patient is not a candidate for aggressive intervention. We developed a prospective study using the same radiotherapy schedule as the Radiation Therapy Oncology Group (RTOG) 85-02 with the addition of the radiosensitizer paclitaxel to evaluate its effect on the tumor response rate, palliation of symptoms, and toxicity.


METHODS
Twenty subjects with advanced pelvic or head and neck cancer were enrolled after signing an informed consent. Paclitaxel 60 mg/m(2) was administered 1 hour prior to the first day of each radiation cycle. Radiation therapy was delivered in 2 daily fractions of 3.7 Gy for 2 days every 3 weeks for three cycles (total dose 44.4 Gy). This radiotherapy schedule is referred to as "Quad Shot'' at our institution.


RESULTS
Nineteen patients had adequate follow-up data and were considered evaluable. Five patients had a complete response (CR) and 13 patients had a partial response (PR) with symptomatic improvement for a response rate of 94.7%. One patient only had a minimal response. Seventeen patients (89.5%) had palliation of their presenting symptom(s). Eight patients had effective palliative benefit lasting more than 6 months. Two patients experienced a grade 2 allergic reaction to paclitaxel, one of them received the last cycle of treatment with cisplatin obtaining a CR. No late toxicities have been observed.


CONCLUSIONS
This palliative schedule has been shown to provide good tumor response and palliation of symptoms. The toxicity profile remains low with the addition of paclitaxel. Further investigation is warranted in a larger trial. Palliation of symptoms resulted in improved quality of life for this group of patients.
Carrascosa
Luis A
LA
Department of Radiation Oncology/Radiotherapy, University of Louisville, Louisville, Kentucky 40202, USA. lcarrascosa@rboi.com
Yashar
Catheryn M
CM
Paris
Kristie J
KJ
Larocca
Renato V
RV
Faught
Samuel Ryan
SR
Spanos
William J
WJ
D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010166:Palliative Care; D011446:Prospective Studies; D015996:Survival Rate; D014481:United States