Comparison of carboplatin-paclitaxel to docetaxel-cisplatin-5-flurouracil induction chemotherapy followed by concurrent chemoradiation for locally advanced head and neck cancer.
OBJECTIVE
In head and neck squamous cell carcinoma (HNSCC), docetaxel, cisplatin and 5-fluorouracil (TPF) has become an accepted induction chemotherapy regimen. However, carboplatin-paclitaxel (CT) regimens have shown comparable outcomes. Here, we compared the outcomes of patients treated with either TPF or CT as induction chemotherapy followed by definitive chemoradiation.


METHODS
We performed a single-institution retrospective analysis of patients with Stage III-IV HNSCC. From a database of 803 patients, we identified 143 patients treated with TPF or CT induction chemotherapy between 1999 and 2012.


RESULTS
53 patients and 90 patients received TPF or CT induction chemotherapy, respectively. The median follow-up was 18.9 months. The 1 year locoregional control was 80.5% for CT compared to 55.5% for TPF (HR 0.32, P=.0002). The 1 year progression free survival was 73.2% for CT compared to 60.7% for TPF (HR 0.57; P=.02). On multivariable analysis, CT remained significant for LRC (HR 0.28; P=0.04). TPF induction chemotherapy was associated with worse renal toxicity as measured by peak creatinine increases during induction chemotherapy (P=0.001). TPF was also associated with a trend toward more chemotherapy dose reductions or changes in systemic agents during concurrent chemoradiation (43.4% for TPF vs. 27.8% for CT; P=0.06).


CONCLUSIONS
Compared to TPF induction chemotherapy, CT induction chemotherapy had at least similar if not better LRC and PFS in patients while having less renal toxicity. Thus, CT induction chemotherapy may benefit patients with locally advanced HNSCC by facilitating adequate chemoradiation regimens that enhanced disease control.
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC 9006, Chicago, IL 60612, United States; Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, 1801 W. Taylor Street, Room C400, Chicago, IL 60637, United States.
Lauren C
LC
Herman
Section of Hematology/Oncology, Department of Medicine, University of Illinois Hospital and Health Sciences System, 840 South Wood Street, Suite 820-E CSB, MC 713 Chicago, IL 60612, United States.
Lucy
L
Chen
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC 9006, Chicago, IL 60612, United States.
Alexandra
A
Garnett
Section of Hematology/Oncology, Department of Medicine, University of Illinois Hospital and Health Sciences System, 840 South Wood Street, Suite 820-E CSB, MC 713 Chicago, IL 60612, United States.
Lawrence E
LE
Feldman
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC 9006, Chicago, IL 60612, United States.
Brett
B
Smith
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC 9006, Chicago, IL 60612, United States; Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, 1801 W. Taylor Street, Room C400, Chicago, IL 60637, United States.
Ralph R
RR
Weichselbaum
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC 9006, Chicago, IL 60612, United States; Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, 1801 W. Taylor Street, Room C400, Chicago, IL 60637, United States. Electronic address: mspiotto@radonc.uchicago.edu.
Michael T
MT
Spiotto
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage
D043823:Taxoids; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil
CT; FFDM; HNSCC; Head and neck cancer; Induction chemotherapy; KPS; Karnofsky performance status; LRC; MVA; OS; PF; PFS; RT; Radiation therapy; THFX; TPF; TPF protocol; UVA; carboplatin–paclitaxel; cisplatin, 5-fluorouracil; docetaxel, cisplatin, 5-fluoruracil; freedom from distant metastasis; head and neck squamous cell carcinoma; locoregional control; multivariate analysis; overall survival; paclitaxel, 5FU, hydroxyurea; progression free survival; radiotherapy; univariate analysis