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Concurrent chemoradiation with paclitaxel in locally advanced head and neck cancer: A feasibility study from tertiary cancer care center

Anjan Bera, Chandrima Banerjee, Shatarupa Dutta, Linkon Biswas.


Abstract

Background: In India, the majority of the head and neck squamous cell carcinoma (SCC) of head and neck (60–80%) presented in locally or locoregionally advanced stage but non-metastatic disease as compared to 40% in developed nations. Uncontrolled local and/or locoregional disease causes most fatalities and predominant failure pattern is local and/or locoregional. Concurrent chemoradiation (CRT) is now standard of care. However, regarding either the optimal scheduling of chemotherapy regimen or radiotherapy (RT) dose fractionation scheme, no consensus exists. Paclitaxel is also active agents against squamous cell carcinoma of head and neck. Weekly paclitaxel appeared to be equivalent to weekly cisplatin with concurrent radiation in the treatment of locally advanced SCC of head and neck cancer (HNC). Concurrent chemoradiotherapy with paclitaxel in locally advanced head and neck malignancy is recommended in NCCN Guideline.

Objectives: The aim of our study is feasibility and efficacy of CRT with paclitaxel for the treatment locally advanced HNC in our institute, Nil Ratan Sircar Medical College and Hospital, Kolkata.

Material and Methods: Between January 2014 and December 2018 ninety eight (98) previously untreated patients with locally advanced histologically confirmed carcinoma oral cavity, oropharynx, and hypopharynx treated with CRT. Chemotherapy consisted of paclitaxel at a dose 40 mg/m2 over 1 h given once weekly from 1st week of RT, up to 4–6 cycles. RT consisted of 66 Gy/33#/61/2 weeks, 2 Gy/fraction, delivered by two parallel opposed lateral face and neck and low anterior neck portal, in cobalt 60 machines. Toxicity was graded using Common Terminology Criteria for Adverse Events v3. To assess response to therapy contrast-enhanced computed tomography (CECT) head and neck and/or magnetic resonance imaging head and neck; CECT chest or whole-body fluorodeoxyglucose and positron emission tomography computed tomography scan were done.

Results: Overall complete response (CR) rate seen in 68% and partial response seen in 32% patients. Two-year disease-free survival, progression free survival, and overall survival were 59%, 72% and 85%, respectively. Grade II acute skin reaction seen in 45% patients and Grade III acute skin reaction seen in 55% patients. Similarly, Grades II and III mucosal reaction is seen in 48% and 52% patients. All patients experience Grade II dysphagia and managed conservatively.

Conclusions: CRT with paclitaxel in locally advanced HNC is safe and confers high CR rate with acceptable toxicity. However, more randomized study with large number of patients is needed to come to conclusions regarding its efficacy.

Key words: Paclitaxel; Head and Neck Cancer; Radiotherapy; Efficacy






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