Radiotherapy and concomitant intra-arterial docetaxel combined with systemic 5-fluorouracil and cisplatin for oropharyngeal cancer: a preliminary report--improvement of locoregional control of oropharyngeal cancer.
OBJECTIVE
To confirm the advantage of chemoradiotherapy using intra-arterial docetaxel with intravenous cisplatin and 5-fluorouracil.


METHODS
A total of 26 oropharyngeal cancer patients (1, 2, 2, and 21 patients had Stage I, II, III, and IVa-IVc, respectively) were treated with two sessions of this chemoradiotherapy regimen. External beam radiotherapy was delivered using large portals that included the primary site and the regional lymph nodes initially (range, 40-41.4 Gy) and the metastatic lymph nodes later (60 or 72 Gy). All tumor-supplying branches of the carotid arteries were cannulated, and 40 mg/m(2) docetaxel was individually infused on Day 1. The other systemic chemotherapy agents included 60 mg/m(2) cisplatin on Day 2 and 500 mg/m(2) 5-fluorouracil on Days 2-6.


RESULTS
The primary response of the tumor was complete in 21 (81%), partial in 4 (15%), and progressive in 1 patient. Grade 4 mucositis, leukopenia, and dermatitis was observed in 3, 2, and 1 patients, respectively. During a median follow-up of 10 months, the disease recurred at the primary site and at a distant organ in 2 (8%) and 3 (12%) patients, respectively. Three patients died because of cancer progression. Two patients (8%) with a partial response were compromised by lethal bleeding from the tumor bed or chemotherapeutic toxicity. The 3-year locoregional control rate and the 3-year overall survival rate was 73% and 77%, respectively.


CONCLUSIONS
This method resulted in an excellent primary tumor response rate (96%) and moderate acute toxicity. Additional follow-up is required to ascertain the usefulness of this modality.
Oikawa
Hirobumi
H
Department of Radiology, Iwate Medical University, Morioka, Japan. oihiro@iwate-med.ac.jp
Nakamura
Ryuji
R
Nakasato
Tatsuhiko
T
Nishimura
Kohji
K
Sato
Hiroaki
H
Ehara
Shigeru
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000188:drug therapy* / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D000077143:Docetaxel; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D009959:Oropharyngeal Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000532:radiotherapy*; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D012074:Remission Induction; D043823:Taxoids
D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil