2808 - Induction Chemotherapy Using Paclitaxel and Carboplatin followed by Altered Fractionated Radiation Therapy in Locally Advanced Head and Neck Carcinoma

Purpose/Objective(s): The standard of care treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) is definitive concomitant chemoradiation (CRT). Since, most of these patients have advanced stage disease and compromised performance status, aggressive treatment with CRT is usually not well-tolerated. Induction chemotherapy (IC) may provide a tool to downstage the disease with resultant improved performance status and may provide a good chance for organ preservation. Furthermore, IC bridges the time gap till the start of definitive chemoradiation, as there is long waiting time for radiation therapy appointments. The objective of this study was to assess the disease-free survival (DFS) and overall survival (OS) of IC using paclitaxel and carboplatin followed by altered fractionated radiation therapy (AFRT) in locally advanced HNC.

Materials/Methods: A total of 117 patients, with biopsy proven locally advanced HNSCC were included. Patients with primary tumor in oral cavity (n=30), oropharynx (n=23), larynx (n=29) and hypopharynx (n=35) having tumor, node, metastatic (TNM) stage between III to IVB were enrolled for the study. The patients were scheduled to receive three cycles of IC using paclitaxel and carboplatin every three weeks in a dose of 175 mg/m² and AUC=5 respectively on D1 of each cycle. After three cycles of IC, patients were planned for AFRT. A total dose of 55 Gray (Gy) was planned on linear accelerator (at least conformal radiotherapy was delivered) with 2.75 Gy per fraction and five fractions per week. Maximum dose to spinal cord was limited to 33 Gy. The patients, who developed grade 3 or 4 toxicity related to chemotherapy or radiation therapy, were allowed treatment breaks to recover from the respective toxicity. The response was assessed after 6 weeks of completion of treatment using CT scan head and neck with contrast. Primary end point was to assess disease free survival (DFS) while overall survival (OS) was also assessed as a secondary end point.

Results: A total of 109 patients (93%) completed the scheduled treatment and were evaluated while rest of the patients couldn’t complete the treatment protocol. Eleven patients (10%) showed disease progression during treatment and were shifted to other therapy. DFS and OS were calculated for a total of 98 patients. Three-year DFS and OS were 42% and 49% respectively. Mean and median DFS (year) were 3.59±0.18 (95% confidence interval [CI] 3.23-3.95) and 3.76±0.32 (CI 3.12-4.40) respectively. Mean and median OS (year) were 4.23±0.15 (CI 3.93-4.53) and 4.32±0.26 (CI 3.80-4.84) respectively.

Conclusion: We concluded that induction chemotherapy using paclitaxel and carboplatin followed by altered fractionated radiation therapy in locally advanced head and neck squamous cell carcinoma is an effective option with reasonable toxicity.