Selective Organ Preservation in Operable Locally Advanced Head and Neck Squamous Cell Carcinomas Guided by Primary Site Restaging Biopsy: Long-Term Results of Two Sequential Brown University Oncology Group Chemoradiotherapy Studies
The long-term outcomes of selective organ preservation in operable, locally advanced head and neck cancers in two sequential chemoradiotherapy (CRT) protocols (HN-53, HN-67) are reported.
A total of 65 patients were treated with CRT consisting of carboplatin (AUC = 1/week) and paclitaxel (60 or 40 mg/m2/week) with radiation (1.8 Gy/day). After 5 weeks of CRT, if primary site biopsies were pathologically negative, then completion CRT to 67–72 Gy was done with neck dissection in node-positive cases. Alternatively, a positive rebiopsy required primary site resection and neck dissection followed by radiotherapy boost as deemed necessary.
Pathologic complete responses occurred in 71% patients who then completed CRT; the remaining 29% patients underwent primary site surgery. The 5-year and median overall survival were 47% and 57 months with no statistically significant differences between the two groups. Overall long-term failure rates were: 6% local, 6% regional, and 32% distant.
This strategy of selective organ preservation was effective in 71% patients with CRT, whereas salvage surgery was required in the remainder. Long-term survival was equivalent in both treatment groups.
KeywordsPaclitaxel Neck Dissection Percutaneous Endoscopic Gastrostomy Pathologic Complete Response Organ Preservation
- 4.Forastiere AA, Maor M, Weber RS, et al. Long-term results of Intergroup RTOG 91-11: a phase III trial to preserve the larynx-induction cisplatin/5-FU and radiation therapy versus concurrent cisplatin and radiation therapy versus radiation therapy [abstract]. J Clin Oncol. 2006;24(18S):5517.Google Scholar
- 7.Wanebo HJ, Chougule P, Ready N, et al. Preoperative paclitaxel, carboplatin, and radiation therapy in advanced head and neck cancer (stage III and IV). Semin Radiat Oncol. 1999;9(2 Suppl 1):77–84.Google Scholar
- 8.Wanebo HJ, Chougule P, Ready N, et al. Preoperative therapy with reduced dose paclitaxel, and carboplatin and radiation achieves a similar complete response rate to a high dose regimen, but with reduced toxicity [abstract 1655]. Proc Am Soc Clin Oncol. 2000;19.Google Scholar
- 9.Ready N, Chougule P, Nadeem A, et al. Induction weekly paclitaxel and carboplatin (IT) followed by concurrent paclitaxel, carboplatin and radiotherapy (CRT) in advanced head and neck squamous cell cancers (HN-SCC) [abstract 943]. Proc Am Soc Clin Oncol. 2002;21.Google Scholar
- 10.Rathore R, Chougule P, Wanebo HJ, et al. Phase I/II study of induction weekly paclitaxel, ifosfamide, and carboplatin (PIC) followed by chemoradiotherapy (CRT) in locally advanced head and neck squamous cell cancer (HNSCC): a Brown University Oncology Group study (HN-86) [abstract 5602]. Proc Am Soc Clin Oncol. 2004;23.Google Scholar
- 28.Shipley WU, Winter KA, Kaufman DS, et al. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol. 1998;16:3576–83.PubMedGoogle Scholar
- 29.Kaufman DS, Winter KA, Shipley WU, et al. The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist. 2000;5:471–6.PubMedCrossRefGoogle Scholar
- 30.Wanebo HJ, Ghebremichael M, Burtness B, et al. Phase II induction cetuximab (C225), paclitaxel (P), and carboplatin (C) followed by chemoradiation with C225, P, C, and RT 68-72 Gy for stage III/IV head and neck squamous cancer: Primary site organ preservation and disease control at 2 years (ECOG, E2303) [abstract 5513]. J Clin Oncol. 2010;(Suppl)28:15s.Google Scholar