• 9/20/2003
  • New York
  • Reuters Health

Induction chemotherapy appears to reduce distant disease failure rates following intensive concomitant chemoradiotherapy when administered to patients with advanced head and neck cancer.

Physicians at a Chicago-area network of hospitals observed high locoregional control, organ preservation, and overall survival rates when they treated patients with intensified concomitant chemoradiotherapy. The biggest problem appeared to be distant failure.

To eradicate systemic micrometastases, Dr. Everett E. Vokes, of the University of Chicago, and colleagues added an inductive regimen of carboplatin and paclitaxel administered in 6 weekly cycles. According to their report in the Journal of Clinical Oncology for January 15, three patients presented with stage III disease and 66 with stage IV disease.

After 6 weeks, 87% of 61 patients with remaining disease following initial organ-preserving surgery exhibited a response and 35% a complete response.

Beginning 2 to 3 weeks later, the patients underwent five cycles of treatment with paclitaxel, fluorouracil, hydroxyurea and twice-daily radiation therapy administered every other week. The patients were then followed for a median of 28 months.

Fifty patients survived until the end of the study period in 2002, for an overall survival rate of 70%, the report indicates. Ten had died of disease persistence or recurrence and three of complications related to therapy. Five died of unrelated causes and one of a second malignancy. “The great majority of patients were treated without disabling surgery,” the physicians note.

The 3-year progression-free rate among those who survived was 80%. Systemic progression occurred in five subjects. These rates “are among the highest published in the literature,” Dr. Vokes and his associates write.

They suggest that the combined protocol reduced distant disease failure rates, but that a randomized trial is needed for “definitive proof.” They recommend further studies to define the optimal regimen for increasing disease control, reducing toxicity or both.