Concomitant infusional paclitaxel and fluorouracil, oral hydroxyurea, and hyperfractionated radiation for locally advanced squamous head and neck cancer

被引:129
作者
Kies, MS
Haraf, DJ
Rosen, F
Stenson, K
List, M
Brockstein, B
Chung, T
Mittal, BB
Pelzer, H
Portugal, L
Rademaker, A
Weichselbaum, R
Vokes, EE
机构
[1] Univ Chicago, Med Ctr, Dept Radiat & Cellular Oncol, Sect Hematol Oncol, Chicago, IL 60637 USA
[2] Univ Chicago, Ctr Comprehens Canc, Chicago, IL 60637 USA
[3] Univ Texas, MD Anderson Canc Ctr, Dept Thorac Head & Neck Med Oncol, Houston, TX 77030 USA
[4] Univ Illinois, Ctr Canc, Dept Med, Chicago, IL 60680 USA
[5] Univ Illinois, Ctr Canc, Dept Radiat Oncol, Chicago, IL 60680 USA
[6] Northwestern Univ, Sch Med, Dept Radiol, Chicago, IL 60611 USA
[7] Northwestern Univ, Sch Med, Dept Otolaryngol Head & Neck Surg, Chicago, IL 60611 USA
[8] Northwestern Univ, Sch Med, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA
关键词
D O I
10.1200/JCO.2001.19.7.1961
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To improve local disease control and survival with organ preservation, we conducted ct phase II multi-institutional trial with a concomitant taxane-based chemotherapy and hyperfractionated radiation regimen. Patients and Methods: Sixty-four patients with locally advanced squamous cancers (stage IV, 98%; N2/3, 81%) were treated on fin intensive regimen consisting of 5-day (120-hour) infusions of paclitaxel 120 mg/m(2)/d) and fluorouracil (600 mg/m2/d), oral hydroxyurea 500 mg every 12 hours for 11 doses, and radiation 1.5 Gy bid (T-FH2X). Chemoradiation was administered concomitantly on days 1 to 5 of each 14-day cycle. A full treatment course consisted of five cycles during a 10-week period to a total radiation dose of 72 to 75 Gy. Results: The median follow-up for the group is 34 months. At 3 years, progression-free survival is 63%, locoregional control is 86%, and systemic control is 79%; overall survival is 60%. Seventeen patients died of recurrent cancer, two died of second primary cancers, and four died of other causes. Side effects observed include anemia (22% required transfusion), leucopenia (34%, grade 3 to 4), and mucositis (84%, grade 3 to 4). Organ preservation principles were maintained. At 1 year posttreatment, 61% of patients had revere xerostomia and 47% had compromised swallowing. There was little disturbance of speech quality in 97% of patients at the same follow-up point. Conclusion T-FH2X is a highly active and tolerable concomitant chemotherapy and hyperfractionated radiation regimen that induces sustained local tumor control and holds promise for improved survival with organ preservation in high-risk patients. Identification of less toxic therapy and improved distant disease control are needed. T-FH2X should be tested in a randomized trial and compared with a less intensive concomitant regimen that uses once-daily radiation fractionation. (C) 2001 by American Society of Clinical Oncology.
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页码:1961 / 1969
页数:9
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