Intensity-Modulated Radiation Therapy with Concurrent Carboplatin and Paclitaxel for Locally Advanced Head and Neck Cancer: Toxicities and Efficacy

Abstract

Background. Intensity-modulated radiation therapy (IMRT) and alternative chemotherapy regimens strive to maintain efficacy while minimizing toxicity in locally advanced head and neck cancer (LAHNC) treatment. Our experience with concurrent IMRT and taxane-based chemotherapy is presented.Methods. A retrospective review of 150 consecutive patients with LAHNC treated with IMRT and concurrent taxane-based chemotherapy with curative intent was performed. The IMRT fractionation regimen consisted of 69.3 Gy to gross disease (2.1 Gy/fraction) and 56.1 Gy to prophylactic nodal sites (1.7 Gy/fraction). Weekly paclitaxel (30 mg/m 2 ) and carboplatin (area under the concentration-time curve [AUC], 1) were given concurrently to all patients, and 69% received weekly induction with paclitaxel (60 mg/m 2 ) and carboplatin (AUC, 2). Results. Over 90% of patients received the prescribed radiation dose. Ninety-six percent completed five or

A comparative analysis between sequential boost and integrated boost intensity-modulated radiation therapy with concurrent chemotherapy for locally-advanced head and neck cancer

“…Alternative induction and concurrent chemotherapy regimens are listed in Additional file 1: Table S1. Two sequential boost patients (3%) required a >5 consecutive day break from radiation treatment, similar to the 5% observed in the SIB cohort [13]. A greater percentage of patients in the sequential boost cohort received 4 or less cycles of concurrent chemotherapy (24% vs. 4%, p  < 0.001).…”

“…Induction carboplatin/paclitaxel was typically offered to individuals with bulky tumors or lymphadenopathy and/or lower cervical lymphadenopathy, and was previously shown to be well-tolerated with 15% or less grade 3 and 0–1.5% grade 4 hematologic toxicity [13]. The potential impact of induction chemotherapy on subsequent toxicity during chemoradiation is difficult to ascertain in our study given the small fraction of patients who did not receive induction.…”

“…The median age at diagnosis was 60 (range, 30 to 75) in the sequential cohort and 57 (range, 37–88) in the SIB cohort. Median follow up in the sequential boost cohort is 30.6 months (range, 6.1 to 54.7 months for surviving patients), whereas the SIB cohort, upon update from initial analysis [13], had a median follow up of 57.8 months (range, 2.4 to 97.1 months). There was a male predominance in both groups, and the majority of patients had stage IVA disease and primary oropharyngeal cancer.…”

“…While cisplatin and carboplatin/paclitaxel have not been directly compared in a randomized fashion, this combination is often utilized as primary induction or concurrent chemotherapy or for patients unable to tolerate cisplatin, and our group and others have reported comparable treatment outcomes and acceptable toxicities [13, 20–22]. Furthermore, rates of high grade toxicity with concurrent carboplatin/paclitaxel seen in our SIB cohort are comparable with rates reported with cisplatin or 5-FU-containing regimens [13, 15, 17, 19]. Nevertheless, whether the differences seen in acute toxicity between SIB and sequential boost in our study would apply to patients receiving traditional cisplatin-based chemotherapy is not entirely clear and would require further evaluation.…”

“…Follow-up was performed as described previously [13]. Biopsy of suspicious lesions was performed to formally establish treatment failure.…”