PROVIDENCE, RI--Weekly chemotherapy with carboplatin (Paraplatin) and
paclitaxel (Taxol) followed by irradiation resulted in a 91% overall
response rate in patients with inoperable cancer of the head and neck.
The regimen led to 20 complete responses and 10 partial responses
among 33 patients. Post-treatment biopsies confirmed the absence of
residual disease in 17 of the 20 patients who had a complete
response, Prakash Chougule, MD, of the Brown University Oncology
Group, said at an ASCO poster session.
All patients had histologically documented grade 3-4 squamous cell
carcinoma of the head and neck. No patient had received prior
radiation therapy or chemotherapy. Involved sites included the larynx
(9 patients), hypopharynx (7), oropharynx (8), oral cavity (6), and
nasopharynx (3). Sixteen patients had positive lymph nodes.
Each patient received 8 weekly cycles of therapy with paclitaxel at a
dose of 60 mg/m² and carbo-platin dosed to an AUC of 1, with
concurrent fractionated external-beam radiation at a total tumor dose
of 6,660 cGy to 7,200 cGy.
At a median follow-up of about a year and a half, only three patients
had not responded to the therapy. On the basis of post-therapy
biopsies, 61% of patients had achieved a complete remission, and an
additional 30% had a partial response. Eight patients with clinically
positive lymph nodes had nodal biopsies, and five had pathologically
Mucositis was the major toxicity, as all but three patients developed
grade 3-4 mucosal irritation. Seven patients each had grade 3 skin
toxicity and candidal infections. Three patients became dehydrated,
and two experienced neuromotor effects.
The results suggest that the therapy might extend the possibility of
organ preservation to more patients, Dr. Chougule and his colleagues
concluded, but longer follow-up is necessary to determine whether the
therapy confers a survival advantage.