Favorable survival observed after carboplatin, paclitaxel, and concurrent accelerated hyperfractionated radiotherapy for treatment of locally advanced head and neck carcinoma

Carter, Dennis L.; Asmar, Lina; Barrera, David; Caracandas, John; Dakhil, J. Shaker; McCracken, Dean; O’Rourke, Mark Allen; Rosenberg, Richard K.; Boehm, Kristi A.; Ilegbodu, D.; Reid, Robert L.

doi:10.1007/s10637-008-9128-1

Cited by 9 publications

(7 citation statements)

References 30 publications

(30 reference statements)

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“…The majority of publications refer to the first mentioned option. [7][8][9][10][11][12][13][14][15] Less frequent were attempts of RT as an alone utility. [16][17][18][19][20] Some individual publications describe a combination of RT and surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors reported larger percentages of 2-year OS: 55%, 60%, 71% and 74% for hyperfractionated accelerated RT with concomitant integrated boost, 17 hyperfractionated accelerated RT combined with chemotherapy, 15 neoadjuvant chemotherapy followed by concurrent hyperfractionated radiation therapy and sensitizing chemotherapy 9 and hyperfractionated accelerated RT plus cisplatin, 12 respectively. Some authors described an even better 3-year OS: 57% and 60% for split-course hyperfractionated accelerated radiochemotherapy 14 and accelerated hyperfractionated RT concurrent with carboplatin and paclitaxel, 8 respectively (OS 17% in the CHA-CHA arm). The 5-year OS in our group was 11% for CHA-CHA and 9% for Conv.…”

Section: Discussionmentioning

confidence: 99%

“…Looking at the aforementioned results, it is clearly seen that a better result is only attainable after a combined treatment (accelerated hyperfractionation 1 chemotherapy). 8,9,12,14,15 The only exception is a small retrospective study by Yoney et al 20 -25% of 5-year OS.…”

Section: Discussionmentioning

confidence: 99%

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Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

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Objective: Evaluation of the efficacy and toxicity of splitcourse accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. Methods: We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used.Results: QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. Conclusion: Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. Advances in knowledge: Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.There are, and have been, many attempts to create a clear and effective treatment modality for advanced inoperable head and neck (H&N) cancers. The most common are different combinations of chemoradiotherapy, or different schedules of altered and usually intensive radiation treatment. It is clear that intense dose delivery combined with a high total dose (TD) and short treatment time gives a higher probability of tumour destruction; unfortunately, it is also connected with a higher, usually unacceptable, risk of normal tissue damage. One of the causes of radiation toxicity in such cases is the inability of sufficient repair of healthy tissue damage.The reason for this is the intensity of dose delivery and the lack of time for repopulation of normal cells and proper repair. On the other hand, the accelerated repopulation of squamous cancer cells starts 4 weeks after radiotherapy (RT); therefore, radiation treatment should be completed in that time. Considering the aforementioned facts, we tried to construct a very intense and short RT schedule allowing for normal tissue (mainly mucosa) repair. We went back to the old concept of split-course RT and combined it with accelerated, continuous, intense hyperfractionation.Finally, we proposed twice-a-day irradiation, usi...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

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“…This percentage is very much higher than that of other studies and, probably, would have had a negative impact on the response rate and OS. Secondly, the concurrent schedule differs signifi cantly from trials evaluating concurrent taxanes and radiotherapy [11,12,14,[21][22][23][24]. For example, Matsumoto et al published the results of a study in 25 patients with advanced H&N treated with weekly docetaxel (10 mg/m 2 ) and hyperfractionation radiotherapy (72 Gy at 1.2 Gy twice daily).…”

Section: Discussionmentioning

confidence: 99%

Phase I/II docetaxel plus concurrent hyperfractionated radiotherapy in locally advanced unresectable head and neck cancer (TAX.ES1.102 study)

et al. 2011

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“…Primary assessment of both patients included computed axial tomography (CT) scan and/or magnetic resonance imaging (MRI) of the region, laryngeal biopsies, evaluation for distant metastases with laboratory tests for liver and bone abnormalities, and chest CT scan. The patients were offered the option of organ-sparing chemoradiotherapy based on a regimen used for primary treatment of squamous cell cancer of the head and neck (SCCHN) [28] or surgical laryngectomy followed by adjuvant radiation. Both patients were deemed eligible for chemoradiotherapy based on normal renal and liver function, ECOG performance status of zero, normal hematologic assessment, no serious concomitant illnesses, no evidence of metastases by chest CT scan, and mental capacity of giving informed consent for chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

Organ Preservation for Adenoid Cystic Carcinoma of the Larynx

et al. 2013

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Objectives. Two cases of adenoid cystic carcinoma (ACC) of the larynx were treated with chemoradiotherapy (CRT) for organ preservation. We reviewed case series and current literature to contrast the potential role of primary CRT as an organsparing modality with standard laryngectomy and radiotherapy in patients with laryngeal ACC. Methods. Two treatment-naïve patients with laryngeal ACC treated at Dana-Farber Cancer Institute between 2002 and 2007 were identified. Both patients were offered standard laryngectomy followed by adjuvant radiotherapy or organsparing treatment modality. Results. Both patients were males, aged 57 and 73. The patients completed a course of combined chemoradiotherapy with weekly carboplatin and paclitaxel and 7-8 weeks of radiotherapy to a total dose of 6,600 and 7,000 cGy over 50 and 57 days, respectively. There were no treatment breaks or delays because of toxicity. The major toxicities reported by both patients, as anticipated, were Grade 3 mucositis, desquamative dermatitis, and severe dysphagia, all of which resolved. Both patients are alive with local regional control and functional larynx; one at 112ϩ months with pulmonary metastases at 54 months, and the other disease free at 60ϩ months. Conclusions. Definitive chemoradiation with weekly carboplatin and paclitaxel may be a potential alternative to the current standard of surgery and radiation for patients with locally advanced laryngeal ACC who request an organ-sparing approach. In this group of patients, salvage laryngectomy may be reserved for those who are locally recurrent or chemoradiotherapy resistant. Although CRT provided long-term local regional control in our two patients, there are evident limitations in obtaining evidence for a determination of treatment of rare diseases. This report provides support for following an organ preservation plan in selected patients. The Oncologist 2013;18:579 -583 Implications for Practice: Concurrent chemoradiotherapy may be used for larynx preservation for selected patients with adenoid cystic carcinoma of the larynx when the functional outcome after surgery is expected to be unsatisfactory or when surgical expertise in such procedures is not available. Laryngeal preservation with concurrent chemoradiotherapy with surgery reserved for recurrent disease seems to offer potential for laryngeal preservation without compromising overall survival. Selection of a treatment option: surgery versus organ-sparing chemoradiotherapy will depend on patient choice of treatment, local expertise, and the availability of appropriate support and rehabilitation services.

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Favorable survival observed after carboplatin, paclitaxel, and concurrent accelerated hyperfractionated radiotherapy for treatment of locally advanced head and neck carcinoma

Abstract: We conclude that weekly C + P and concurrent twice-daily hyperfractionated radiotherapy is tolerated and highly active in patients with unresectable, locally advanced squamous cell carcinoma of the head and neck.

Cited by 9 publications

References 30 publications

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Phase I/II docetaxel plus concurrent hyperfractionated radiotherapy in locally advanced unresectable head and neck cancer (TAX.ES1.102 study)

Organ Preservation for Adenoid Cystic Carcinoma of the Larynx

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