Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation

Eric C. Ko, Eric M. Genden, Krzysztof Misiukiewicz, Peter M. Som, Lale Kostakoglu, Chien Ting Chen, Stuart Packer, Johnny Kao

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

The use of induction chemotherapy prior to chemoradiation for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored whether toxicity from induction chemotherapy influenced the delivery of concurrent chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC treated with combined chemotherapy and radiation, we identified 66 patients with stage III-IVB head and neck carcinoma who were treated with induction chemotherapy prior to planned chemoradiation. The most common induction regimen was docetaxel, cisplatin and 5-FU (TPF; 80%) for 2 to 3 cycles. Mean radiation dose was 72 Gy (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26%), cetuximab (5%) and 5-fluorouracil/hydroxyurea (65%)-based regimens. At a median follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and distant control rates were 85 and 86%, respectively. The 2-year disease-free survival and overall survival rates were 74 and 80%, respectively. Although there were no grade 5 toxicities during induction chemotherapy, 26% of patients required hospitalization for adverse events, including 5% needing intensive care. The most common high grade adverse events were grade 4 neutropenia (21%) and neutropenic fever (17%). Six percent of patients were unable to tolerate concurrent chemotherapy. The 2-year disease-free survival was significantly higher in patients able to complete induction and concurrent chemoradiation as planned (83 vs. 27%, p<0.001). Induction chemotherapy followed by concurrent chemoradiation results in promising survival rates in our cohort of advanced head and neck carcinoma patients. Due to severe toxicities in a subset of patients, this strategy is only recommended in selected high-risk patients who are carefully followed by an experienced multidisciplinary team.

Original languageEnglish (US)
Pages (from-to)467-474
Number of pages8
JournalOncology Reports
Volume27
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Fingerprint

Induction Chemotherapy
Head and Neck Neoplasms
docetaxel
Drug Therapy
Fluorouracil
Cisplatin
Disease-Free Survival
Neck
Survival Rate
Head
Radiation
Carcinoma
Hydroxyurea
Critical Care
Neutropenia
Hospitalization
Fever

Keywords

  • Adverse events
  • Concurrent chemoradiation
  • Head and neck cancer
  • Induction chemotherapy
  • Toxicity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation. / Ko, Eric C.; Genden, Eric M.; Misiukiewicz, Krzysztof; Som, Peter M.; Kostakoglu, Lale; Chen, Chien Ting; Packer, Stuart; Kao, Johnny.

In: Oncology Reports, Vol. 27, No. 2, 02.2012, p. 467-474.

Research output: Contribution to journalArticle

Ko, Eric C. ; Genden, Eric M. ; Misiukiewicz, Krzysztof ; Som, Peter M. ; Kostakoglu, Lale ; Chen, Chien Ting ; Packer, Stuart ; Kao, Johnny. / Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation. In: Oncology Reports. 2012 ; Vol. 27, No. 2. pp. 467-474.
@article{fa413c9004954d6d903a90934fcb1d38,
title = "Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation",
abstract = "The use of induction chemotherapy prior to chemoradiation for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored whether toxicity from induction chemotherapy influenced the delivery of concurrent chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC treated with combined chemotherapy and radiation, we identified 66 patients with stage III-IVB head and neck carcinoma who were treated with induction chemotherapy prior to planned chemoradiation. The most common induction regimen was docetaxel, cisplatin and 5-FU (TPF; 80{\%}) for 2 to 3 cycles. Mean radiation dose was 72 Gy (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26{\%}), cetuximab (5{\%}) and 5-fluorouracil/hydroxyurea (65{\%})-based regimens. At a median follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and distant control rates were 85 and 86{\%}, respectively. The 2-year disease-free survival and overall survival rates were 74 and 80{\%}, respectively. Although there were no grade 5 toxicities during induction chemotherapy, 26{\%} of patients required hospitalization for adverse events, including 5{\%} needing intensive care. The most common high grade adverse events were grade 4 neutropenia (21{\%}) and neutropenic fever (17{\%}). Six percent of patients were unable to tolerate concurrent chemotherapy. The 2-year disease-free survival was significantly higher in patients able to complete induction and concurrent chemoradiation as planned (83 vs. 27{\%}, p<0.001). Induction chemotherapy followed by concurrent chemoradiation results in promising survival rates in our cohort of advanced head and neck carcinoma patients. Due to severe toxicities in a subset of patients, this strategy is only recommended in selected high-risk patients who are carefully followed by an experienced multidisciplinary team.",
keywords = "Adverse events, Concurrent chemoradiation, Head and neck cancer, Induction chemotherapy, Toxicity",
author = "Ko, {Eric C.} and Genden, {Eric M.} and Krzysztof Misiukiewicz and Som, {Peter M.} and Lale Kostakoglu and Chen, {Chien Ting} and Stuart Packer and Johnny Kao",
year = "2012",
month = "2",
doi = "10.3892/or.2011.1512",
language = "English (US)",
volume = "27",
pages = "467--474",
journal = "Oncology Reports",
issn = "1021-335X",
publisher = "Spandidos Publications",
number = "2",

}

TY - JOUR

T1 - Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation

AU - Ko, Eric C.

AU - Genden, Eric M.

AU - Misiukiewicz, Krzysztof

AU - Som, Peter M.

AU - Kostakoglu, Lale

AU - Chen, Chien Ting

AU - Packer, Stuart

AU - Kao, Johnny

PY - 2012/2

Y1 - 2012/2

N2 - The use of induction chemotherapy prior to chemoradiation for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored whether toxicity from induction chemotherapy influenced the delivery of concurrent chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC treated with combined chemotherapy and radiation, we identified 66 patients with stage III-IVB head and neck carcinoma who were treated with induction chemotherapy prior to planned chemoradiation. The most common induction regimen was docetaxel, cisplatin and 5-FU (TPF; 80%) for 2 to 3 cycles. Mean radiation dose was 72 Gy (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26%), cetuximab (5%) and 5-fluorouracil/hydroxyurea (65%)-based regimens. At a median follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and distant control rates were 85 and 86%, respectively. The 2-year disease-free survival and overall survival rates were 74 and 80%, respectively. Although there were no grade 5 toxicities during induction chemotherapy, 26% of patients required hospitalization for adverse events, including 5% needing intensive care. The most common high grade adverse events were grade 4 neutropenia (21%) and neutropenic fever (17%). Six percent of patients were unable to tolerate concurrent chemotherapy. The 2-year disease-free survival was significantly higher in patients able to complete induction and concurrent chemoradiation as planned (83 vs. 27%, p<0.001). Induction chemotherapy followed by concurrent chemoradiation results in promising survival rates in our cohort of advanced head and neck carcinoma patients. Due to severe toxicities in a subset of patients, this strategy is only recommended in selected high-risk patients who are carefully followed by an experienced multidisciplinary team.

AB - The use of induction chemotherapy prior to chemoradiation for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored whether toxicity from induction chemotherapy influenced the delivery of concurrent chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC treated with combined chemotherapy and radiation, we identified 66 patients with stage III-IVB head and neck carcinoma who were treated with induction chemotherapy prior to planned chemoradiation. The most common induction regimen was docetaxel, cisplatin and 5-FU (TPF; 80%) for 2 to 3 cycles. Mean radiation dose was 72 Gy (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26%), cetuximab (5%) and 5-fluorouracil/hydroxyurea (65%)-based regimens. At a median follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and distant control rates were 85 and 86%, respectively. The 2-year disease-free survival and overall survival rates were 74 and 80%, respectively. Although there were no grade 5 toxicities during induction chemotherapy, 26% of patients required hospitalization for adverse events, including 5% needing intensive care. The most common high grade adverse events were grade 4 neutropenia (21%) and neutropenic fever (17%). Six percent of patients were unable to tolerate concurrent chemotherapy. The 2-year disease-free survival was significantly higher in patients able to complete induction and concurrent chemoradiation as planned (83 vs. 27%, p<0.001). Induction chemotherapy followed by concurrent chemoradiation results in promising survival rates in our cohort of advanced head and neck carcinoma patients. Due to severe toxicities in a subset of patients, this strategy is only recommended in selected high-risk patients who are carefully followed by an experienced multidisciplinary team.

KW - Adverse events

KW - Concurrent chemoradiation

KW - Head and neck cancer

KW - Induction chemotherapy

KW - Toxicity

UR - http://www.scopus.com/inward/record.url?scp=84862935143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862935143&partnerID=8YFLogxK

U2 - 10.3892/or.2011.1512

DO - 10.3892/or.2011.1512

M3 - Article

C2 - 22020564

AN - SCOPUS:84862935143

VL - 27

SP - 467

EP - 474

JO - Oncology Reports

JF - Oncology Reports

SN - 1021-335X

IS - 2

ER -