Pilot Study of Organ Preservation Multimodality Therapy for Locally Advanced Resectable Oropharyngeal Carcinoma
作者:
Mitchell Machtay,
David Rosenthal,
Kenneth Algazy,
Victor Aviles,
Ara Chalian,
Diane Hershock,
Robin Neubauer,
Michael Greenberg,
Natasha Mirza,
Gregory Weinstein,
Randal Weber,
期刊:
American Journal of Clinical Oncology: Cancer Clinical Trials
(OVID Available online 2000)
卷期:
Volume 23,
issue 5
页码: 509-515
ISSN:0277-3732
年代: 2000
出版商: OVID
关键词: Pilot study;Organ preservation;Multimodality therapy;Oropharyngeal carcinoma.
数据来源: OVID
摘要:
The purpose of this study was to determine the early efficacy and toxicity of a new multimodality organ-preservation regimen for locally advanced, resectable oropharyngeal squamous cell carcinoma (SCC). Patients with T3-4N0-3M0 or T2N2-3M0 oropharyngeal SCC were eligible for this Phase II study. Patients needed the physiologic reserve for surgery and technically resectable tumors. Induction carboplatin (area under the curve = 6) and paclitaxel (200 mg/m2) × 2 cycles (q21 days) were given. Objective responders received definitive radiotherapy (XRT), 70 Gy/7 weeks with concurrent weekly paclitaxel. Initially, the dose of paclitaxel was 50 mg/m2/week; because of mucosal toxicity it was reduced to 30 mg/m2/week. Patients with N2-3 disease received post-XRT neck dissection and 2 more cycles of “adjuvant” chemotherapy. In the first 22 patients, the neutropenic fever rate was 27%. Although there has been no grade IV-V toxicity from induction therapy, grade II-III toxicity resulted in an unacceptable delay in starting XRT in 14% of patients. The response rate to induction chemotherapy was 91%. Grade III mucositis occurred in all patients during concurrent chemoradiotherapy. One patient died of pneumonia during concurrent chemoradiotherapy after receiving 26 Gy and 3 doses of paclitaxel 50 mg/m2. No dose-limiting toxicity occurred in 15 patients treated with concurrent paclitaxel 30 mg/m2/week. Actuarial overall survival at 18 months is 82%; local–regional control is 86%. To date, distant metastases have not developed in any patients. This regimen has intense but acceptable acute toxicity. The maximum tolerated dosage of weekly paclitaxel during standard continuous-course XRT is confirmed to be 30 mg/m2/week. The treatment efficacy of this regimen (response rate and short-term local–regional and distant control) is encouraging. Accrual continues to obtain long-term toxicity, efficacy, and quality-of-life data.
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