title: Induction docetaxel, Cisplatin, and 5-Fluorouracil precludes definitive chemoradiotherapy in a substantial proportion of patients with head and neck cancer in a low socioeconomic status population.
abstract: OBJECTIVE
  In this retrospective study we evaluate the tolerability and outcomes after induction chemotherapy for patients with predominately low socioeconomic status (SES) with locally advanced head and neck cancer (LAHNC).
  
  
  METHODS
  One hundred eighteen patients with LAHNC of the hypopharynx, larynx, oral cavity, or oropharynx began curative intent therapy with induction cisplatin (75 or 100 mg/m), docetaxel (75 mg/m), and 5-fluorouracil (750 mg/m×5 d or 1000 mg/m×4 d; continuous infusion) every 3 weeks (DPF) for a planned 2 to 3 cycles. All patients were to receive curative radiotherapy with concurrent systemic therapy. Associations were tested using χ test, and survival estimates were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Most patients (75.4%) were of low SES. Induction DPF was delivered for a median of 2 cycles (range, 1 to 3) and 14% of the patients (n=17) died during induction DPF. After DPF, 38.2% of patients were unable to complete or receive planned definitive therapy. Overall 15.3% of patients died during therapy, and mortality was associated with a Karnofsky performance status <80 (P=0.04). At 2 years the locoregional control was 52.7%, whereas the distant metastases free rate was 72.6%, and the overall survival rate was 34.1%. Low SES patients were less likely to achieve locoregional control (P=0.05) or survive (P=0.08).
  
  
  CONCLUSIONS
  In this population of LAHNC patients of low SES with a high tumor burden and poor performance status, use of induction DPF was associated with 15.3% mortality during therapy and precluded 38.2% of patients from initiating or completing planned definitive therapy.
authors.affiliation: Departments of *Radiation Oncology §Head and Neck Oncology, Moffitt Cancer Center, Tampa, FL Departments of †Radiation Oncology ‡Medicine ∥Otolaryngology, University of Mississippi Medical Center, Jackson, MS ¶Department of Radiation Oncology, University of Southern California, Los Angeles, CA.
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Caudell
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hamilton
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Otto
authors.forename: Richard L
authors.initials: RL
authors.lastname: Jennelle
authors.forename: Karen T
authors.initials: KT
authors.lastname: Pitman
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Vijayakumar
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D008922:Mississippi; D012189:Retrospective Studies; D012923:Social Class; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D014481:United States
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil