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Concurrent chemoradiation with carboplatin-5fu versus cisplatin in locally advanced oropharyngeal cancers: Is more always better?
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Posters was evaluated in 52 patients (pts) with advanced SCCHN. Materials/Methods: From 10/99 to 12/03, 52 pts (46 male), mean age of 50 years (38-69), PS : 1 (0-2) with advanced unresectable SCCHN (oropharynx :88%,T3-4 : 48pts, N2-3 : 40pts, no distant metastases) received : C :100mg/m 2 on day 1 and FU :450mg/m2/d by continuous 4-day i.v. infusion, or at adjusted dose, on weeks 1,4 and 7. RT was delivered for a total dose of 70 Gy in 7 weeks. Results: Median FU AUC dl-d2 was 9620ng/ml.h (2112-15945) and the initial dose of FU was reduced by 20% in 23 pts. Median total platinum concentrations (conc) h2 and hl 8 were respectively 3045 ng/ml (1100-5375) and 1634 ng/ml (532-2525). Ultrafiltrable platinum conc.(h 18) was superior to 60 ng/ml in 25% of cycles.The most frequent toxicity was mucositis (grade 3-4) in 27 pts (52%). Neutropenia, thrombocytopenia and anaemia (grade 3-4) occurred in 6(12%), 2(4%) and 8(15%)pts. A maxillary radionecrosis occurred in 3 (6%) pts. There were no toxic death. Thirty-six (69%) pts required a feeding tube. Objective response was achieved in 50 (96%) pts and CR in 42 (87%) pts. With a median follow-up of 4,7 years the overall survival at 3 and 5years was 58,8% and 51,2%. Twenty-four pts died: 8 from Ioco regional disease, 8 from metastatic disease, 5 from second primary (lung,oesophagus, prostate) and 3 from non tumoural cause. Conclusions: This regimen with PK adjusted CT shows an excellent Ioco regional control with acceptable toxicity in these selected pts. 149 poster CONCURRENT CHEMORADIATION WITH CARBOPLATIN-SFU VERSUS CISPLATIN IN LOCALLY ADVANCED OROPHARYNGEAL CANCERS: IS MORE ALWAYS BETTER? M. Barkati 1 B. Fortin ~, D. SouliEres%D. Charpentier2, J-C. Tabet3, L. Guertin% M-J. Olivier% G. Coulombe 1,D. Donath% P.F.Nguyen-Tan 1 tNOTRE-DAMEHOSPITAL,CHUM, Radiation Therapy,Montreal,Canada, 2NOTRE-DAMEHOSPITAL,CHUM, MedicalOncology,Montreal,Canada, 3NOTRE-DAMEHOSPITAL,CHUM, Head and Neck Surgery, Montreal, Can-
ada Purpose/Objective: The addition of chemotherapy to radiation therapy in locally advanced head and neck cancers improves disease-free and overall survival. However, the optimal chemotherapy regimen remains to be defined. We compared two platinum-based chemotherapy regimens, in non-metastatic, locally advanced oropharyngeal cancers. Materials/Methods: In this single-institution retrospective study, we reviewed all patients treated for stage III or IV oropharyngeal cancer using either carboplatin (daily bolus of 70 mg/m 2 per day for 4 days) and 5FU (600 mg/m 2 per day for 4 days as a continuous infusion) every 3 weeks or cisplatin 100 mg/m 2 every 3 weeks concomitant with definitive radiation therapy between 1998 and 2006. Survival data were computed using the Kaplan-Meier method and compared using log-rank tests, toxicities were compared using Fisher's exact test. Results: Two hundred and fifty three patients met our criteria. Most of them had conventional radiation therapy given at 2 Gy per day, five times a week for a median dose of 70 Gy. Twelve and 88% had respectively stage III and IV disease. Median age at diagnosis was 57 years. Seventy-six percent were males and 24% females. Two hundred patients were treated with carboplatin-SFU and 53 patients with cisplatin. The number of cycles received was 2 for 41% of patients and 3 for 59%. Median follow-up was 23.5 months. At the time of analysis, median overall survival (OS) and disease-free survival (DFS) were not reached. At three years, OS, DFS and Iocoregional control (LRC) were 81.1%, 82.8% and 90.4% respectively. Comparing carboplatin-SFU to cisplatin the 3y-OS were similar (80.8% vs.
83.0%; p=0.5971 ), as well as the 3y-DFS (83.5% vs. 79.7%; p=0.5407), and the 3y-LRC (89.2% vs. 96.0%; p=0.3594). Complete response rates were also equivalent between the 2 chemotherapy regimens (p=0.3316). For the whole group, after concurrent chemoradiation alone, the complete Iocoregional response rate was 66.5%, with 95.8% complete responses at the primary site and 68.3% in the neck. After planned neck dissection for 76 patients with residual disease in the neck, the complete response rate reached 91.3%. Patients who received 3 cycles of chemotherapy versus 2 cycles did not show a statistically significant difference in 3y-OS (p=0.2698), 3y-DFS (p=0.3516) and 3y-LRC (p=0.6898).Toxicities were similar in the two groups with the exception of grade 3 or 4 neutropenia being more frequent in patients receiving cisplatin (10.1% vs. 27.8%; p=0.0464). Conclusions: In our institutional experience, we did not demonstrate any added benefit for using a platinum-based polychemotherapy vs. monochemotherapy. Our data suggest that 2 cycles of chemotherapy concurrent with radiation might give comparable results to 3 cycles. The choice of chemotherapy regimen should then be based on the toxicity profile, individual patient characteristics and the treating team personal experience. 150 poster CONCURRENT CHEMORADIOTHERAPY FOLLOWED BY ADJUVANT CHEMOTHERAPY WITH CISPLATIN AND DOCETAXEL FOR ADVANCED HEAD AND NECK CANCER. H.Omar KINGABDULAZIZHOSPITAL,OncologyCenter,Jeddah,SaudiArabia
Purpose/Objective: To confirm the efficacy of concurrent chemoradiotherapy followed by three cycles of adjuvant chemotherapy in treating patients with Iocoregional advanced head and neck cancer. Materials/Methods: Between February 2003 and August 2005, 36 patients with advanced head and neck cancer were treated at King Abdul Aziz Hospital & Oncology Center. Jeddah, with a full course of radiotherapy (70 Gy). Patients were scheduled to receive two cycles of concurrent cisplatin (100mg / m 2) administered on weeks 1 and 5 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 3 weeks. All patients were assessed for response immediately after the concomitant phase and at 2 months after completion of treatment. Follow up was maintained for a range from 6 to 36 months. Toxicity profile, pattern of failure, 2-year 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 3 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 3 patients were turned into CR after the adjuvant phase. During the period of follow up, S patients relapsed (3 Iocoregional & 2 systemic relapse).The estimated 2 year disease free and overall survival rates were 78% and 89% respectively. Conclusions: Concurrent chemoradiotherapy had improved the results of treatment in patients with advanced head and neck cancer concerning Iocoregional 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.
Posters was evaluated in 52 patients (pts) with advanced SCCHN. Materials/Methods: From 10/99 to 12/03, 52 pts (46 male), mean age of 50 years (38-69), PS : 1 (0-2) with advanced unresectable SCCHN (oropharynx :88%,T3-4 : 48pts, N2-3 : 40pts, no distant metastases) received : C :100mg/m 2 on day 1 and FU :450mg/m2/d by continuous 4-day i.v. infusion, or at adjusted dose, on weeks 1,4 and 7. RT was delivered for a total dose of 70 Gy in 7 weeks. Results: Median FU AUC dl-d2 was 9620ng/ml.h (2112-15945) and the initial dose of FU was reduced by 20% in 23 pts. Median total platinum concentrations (conc) h2 and hl 8 were respectively 3045 ng/ml (1100-5375) and 1634 ng/ml (532-2525). Ultrafiltrable platinum conc.(h 18) was superior to 60 ng/ml in 25% of cycles.The most frequent toxicity was mucositis (grade 3-4) in 27 pts (52%). Neutropenia, thrombocytopenia and anaemia (grade 3-4) occurred in 6(12%), 2(4%) and 8(15%)pts. A maxillary radionecrosis occurred in 3 (6%) pts. There were no toxic death. Thirty-six (69%) pts required a feeding tube. Objective response was achieved in 50 (96%) pts and CR in 42 (87%) pts. With a median follow-up of 4,7 years the overall survival at 3 and 5years was 58,8% and 51,2%. Twenty-four pts died: 8 from Ioco regional disease, 8 from metastatic disease, 5 from second primary (lung,oesophagus, prostate) and 3 from non tumoural cause. Conclusions: This regimen with PK adjusted CT shows an excellent Ioco regional control with acceptable toxicity in these selected pts. 149 poster CONCURRENT CHEMORADIATION WITH CARBOPLATIN-SFU VERSUS CISPLATIN IN LOCALLY ADVANCED OROPHARYNGEAL CANCERS: IS MORE ALWAYS BETTER? M. Barkati 1 B. Fortin ~, D. SouliEres%D. Charpentier2, J-C. Tabet3, L. Guertin% M-J. Olivier% G. Coulombe 1,D. Donath% P.F.Nguyen-Tan 1 tNOTRE-DAMEHOSPITAL,CHUM, Radiation Therapy,Montreal,Canada, 2NOTRE-DAMEHOSPITAL,CHUM, MedicalOncology,Montreal,Canada, 3NOTRE-DAMEHOSPITAL,CHUM, Head and Neck Surgery, Montreal, Can-
ada Purpose/Objective: The addition of chemotherapy to radiation therapy in locally advanced head and neck cancers improves disease-free and overall survival. However, the optimal chemotherapy regimen remains to be defined. We compared two platinum-based chemotherapy regimens, in non-metastatic, locally advanced oropharyngeal cancers. Materials/Methods: In this single-institution retrospective study, we reviewed all patients treated for stage III or IV oropharyngeal cancer using either carboplatin (daily bolus of 70 mg/m 2 per day for 4 days) and 5FU (600 mg/m 2 per day for 4 days as a continuous infusion) every 3 weeks or cisplatin 100 mg/m 2 every 3 weeks concomitant with definitive radiation therapy between 1998 and 2006. Survival data were computed using the Kaplan-Meier method and compared using log-rank tests, toxicities were compared using Fisher's exact test. Results: Two hundred and fifty three patients met our criteria. Most of them had conventional radiation therapy given at 2 Gy per day, five times a week for a median dose of 70 Gy. Twelve and 88% had respectively stage III and IV disease. Median age at diagnosis was 57 years. Seventy-six percent were males and 24% females. Two hundred patients were treated with carboplatin-SFU and 53 patients with cisplatin. The number of cycles received was 2 for 41% of patients and 3 for 59%. Median follow-up was 23.5 months. At the time of analysis, median overall survival (OS) and disease-free survival (DFS) were not reached. At three years, OS, DFS and Iocoregional control (LRC) were 81.1%, 82.8% and 90.4% respectively. Comparing carboplatin-SFU to cisplatin the 3y-OS were similar (80.8% vs.
83.0%; p=0.5971 ), as well as the 3y-DFS (83.5% vs. 79.7%; p=0.5407), and the 3y-LRC (89.2% vs. 96.0%; p=0.3594). Complete response rates were also equivalent between the 2 chemotherapy regimens (p=0.3316). For the whole group, after concurrent chemoradiation alone, the complete Iocoregional response rate was 66.5%, with 95.8% complete responses at the primary site and 68.3% in the neck. After planned neck dissection for 76 patients with residual disease in the neck, the complete response rate reached 91.3%. Patients who received 3 cycles of chemotherapy versus 2 cycles did not show a statistically significant difference in 3y-OS (p=0.2698), 3y-DFS (p=0.3516) and 3y-LRC (p=0.6898).Toxicities were similar in the two groups with the exception of grade 3 or 4 neutropenia being more frequent in patients receiving cisplatin (10.1% vs. 27.8%; p=0.0464). Conclusions: In our institutional experience, we did not demonstrate any added benefit for using a platinum-based polychemotherapy vs. monochemotherapy. Our data suggest that 2 cycles of chemotherapy concurrent with radiation might give comparable results to 3 cycles. The choice of chemotherapy regimen should then be based on the toxicity profile, individual patient characteristics and the treating team personal experience. 150 poster CONCURRENT CHEMORADIOTHERAPY FOLLOWED BY ADJUVANT CHEMOTHERAPY WITH CISPLATIN AND DOCETAXEL FOR ADVANCED HEAD AND NECK CANCER. H.Omar KINGABDULAZIZHOSPITAL,OncologyCenter,Jeddah,SaudiArabia
Purpose/Objective: To confirm the efficacy of concurrent chemoradiotherapy followed by three cycles of adjuvant chemotherapy in treating patients with Iocoregional advanced head and neck cancer. Materials/Methods: Between February 2003 and August 2005, 36 patients with advanced head and neck cancer were treated at King Abdul Aziz Hospital & Oncology Center. Jeddah, with a full course of radiotherapy (70 Gy). Patients were scheduled to receive two cycles of concurrent cisplatin (100mg / m 2) administered on weeks 1 and 5 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 3 weeks. All patients were assessed for response immediately after the concomitant phase and at 2 months after completion of treatment. Follow up was maintained for a range from 6 to 36 months. Toxicity profile, pattern of failure, 2-year 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 3 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 3 patients were turned into CR after the adjuvant phase. During the period of follow up, S patients relapsed (3 Iocoregional & 2 systemic relapse).The estimated 2 year disease free and overall survival rates were 78% and 89% respectively. Conclusions: Concurrent chemoradiotherapy had improved the results of treatment in patients with advanced head and neck cancer concerning Iocoregional 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.