title: Intensity-modulated radiation therapy with concurrent carboplatin and paclitaxel for locally advanced head and neck cancer: toxicities and efficacy.
abstract: BACKGROUND
  Intensity-modulated radiation therapy (IMRT) and alternative chemotherapy regimens strive to maintain efficacy while minimizing toxicity in locally advanced head and neck cancer (LAHNC) treatment. Our experience with concurrent IMRT and taxane-based chemotherapy is presented.
  
  
  METHODS
  A retrospective review of 150 consecutive patients with LAHNC treated with IMRT and concurrent taxane-based chemotherapy with curative intent was performed. The IMRT fractionation regimen consisted of 69.3 Gy to gross disease (2.1 Gy/fraction) and 56.1 Gy to prophylactic nodal sites (1.7 Gy/fraction). Weekly paclitaxel (30 mg/m(2)) and carboplatin (area under the concentration-time curve [AUC], 1) were given concurrently to all patients, and 69% received weekly induction with paclitaxel (60 mg/m(2)) and carboplatin (AUC, 2).
  
  
  RESULTS
  Over 90% of patients received the prescribed radiation dose. Ninety-six percent completed five or more cycles of concurrent chemotherapy, with similar tolerability for induction chemotherapy. A percutaneous endoscopic gastrostomy (PEG) tube was required in 80 patients, with 10 maintaining PEG use >18 months. Acute grade 4 mucositis and dermatitis developed in 2.0% and 4.0% of patients, respectively. No patient experienced nadir sepsis, grade ≥3 late xerostomia, or significant nephropathy or gastrointestinal toxicity. Median follow-up was 30 months. The 3-year locoregional control rate was 83.2% with disease-free survival and overall survival rates of 78.8% and 76.5%, respectively.
  
  
  CONCLUSIONS
  Rates of acute and late toxicities were low, with excellent radiation dose delivery and impressive tumor control at 3 years, suggesting that concurrent carboplatin and paclitaxel with IMRT is a reasonable therapeutic option for the curative treatment of LAHNC.
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5671, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Vlacich
authors.forename: Roberto
authors.initials: R
authors.lastname: Diaz
authors.forename: Steven W
authors.initials: SW
authors.lastname: Thorpe
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
authors.forename: Wyndee
authors.initials: W
authors.lastname: Kirby
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sinard
authors.forename: Bashar
authors.initials: B
authors.lastname: Shakhtour
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: Patrick
authors.initials: P
authors.lastname: Murphy
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.forename: Wendell G
authors.initials: WG
authors.lastname: Yarbrough
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cmelak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel