Concurrent Chemoradiotherapy Followed by Adjuvant Chemotherapy with Cisplatin and Docetaxel for Advanced Head and Neck Cancer

Abstract

background: Concurrent chemoradiotherapy (CRT) is the most effective approach in controlling advanced head and neck cancer. Cisplatin is the most extensively cytotoxic agent investigated concurrently with radiation therapy as well as in neoadjuvent and adjuvant setting, also the taxanes (paclitaxel and docetaxel) have demonstrated significant activity in head and neck cancer so we started this study to confirm the efficacy of concurrent chemoradiotherapy followed by three cycles of adjuvant chemotherapy (cisplatin and docetaxel) in treating patients with locoregional advanced head and neck cancer. patient and Methods: Between February 2003 and August 2005, 36 patients with advanced head and neck cancer were treated at King Abdul Aziz Hospital and Oncology Center Jeddah, with a full course of conventional radiotherapy (70 Gy). Patients were scheduled to receive two cycles of concurrent cisplatin (100mg/m 2) administered on weeks one and five of radiotherapy. Subsequently a further three cycles of adjuvant chemotherapy comprising a combination of cisplatin (60mg/m 2) and docetaxel (60mg/m 2) repeated every three weeks. All patients were assessed for response immediately after the concomitant phase and at two months after completion of treatment. Follow up was maintained for a range from 6 to 36 months. Toxicity profile, pattern of failure, two years disease free and overall survival rates were estimated. Results: The median age of patients was 44 years with male to female ratio of 2.3:1. 64% of the patients had a primary tumor of the nasopharynx. Undifferentiated carcinoma was the major pathological subtype. The planned dose of radiotherapy was completed in 92% of patients, and 83% completed the three cycles of adjuvant chemotherapy. Mucositis and neutropenia were the commonly recorded side effects, with no reported toxic death. 31 patients went into complete remission (CR) after the first phase of treatment. Another three patients were turned into CR after the adjuvant phase. During the period of follow up, five patients relapsed (three locoregional & two systemic relapse). The estimated two year disease free and overall survival rates were 78% and 89% respectively. Conclusion: Concurrent chemoradiotherapy had improved the results of treatment in patients with advanced head and neck cancer concerning locoregional control, disease free survival and overall survival; however more was achieved, especially concerning reduction of distant failure, by addition of adjuvant chemotherapy. Docetaxel in combination with cisplatine is reported to be an effective combination in the adjuvant setting.