BACKGROUND: We hypothesized induction chemotherapy (IndCT) would improve distant control (DC) without compromising locoregional control (LRC) for locoregionally advanced head and neck cancer patients. Additionally, we systematically lowered radiotherapy (RT) doses attempting to maintain LRC while decreasing toxicity. PATIENTS AND METHODS: Stages III-IV (M0) locoregionally advanced head and neck cancer patients received carboplatin/paclitaxel (Taxol) IndCT followed by four or five cycles consisting of 5 days of paclitaxel, fluorouracil, hydroxyurea, and BID RT followed by a nine day break. RT dose to gross disease (high risk), intermediate, and low-risk volumes were reduced from cohort A (n = 68): 75, 60, and 45 Gy; to cohort B (n = 64): 75, 54, and 39 Gy; then cohort C (n = 90): 72, 51, and 36 Gy. RESULTS: A total of 222 patients accrued from November 1998 to September 2002. Median follow-up is 56 months. In all, 93/96/76% achieved a complete response to concurrent chemoradiotherapy (CRT) in cohort A/B/C. Three- and 5-year overall survivals (OSs) are 68% and 62%, respectively. Five-year LRC and DC are 91% and 87%, respectively. Response to IndCT predicted for OS, LRC, and time to progression (TTP). Cohort C patients had similar OS (P = 0.95), LRC, and DC, but worse (TTP) (P = 0.027). CONCLUSIONS: IndCT before CRT reduces distant progression while maintaining high LRC. The cohort B schedule provides the best therapeutic ratio. A randomized trial investigating IndCT before CRT has been initiated.
BACKGROUND: We hypothesized induction chemotherapy (IndCT) would improve distant control (DC) without compromising locoregional control (LRC) for locoregionally advanced head and neck cancerpatients. Additionally, we systematically lowered radiotherapy (RT) doses attempting to maintain LRC while decreasing toxicity. PATIENTS AND METHODS: Stages III-IV (M0) locoregionally advanced head and neck cancerpatients received carboplatin/paclitaxel (Taxol) IndCT followed by four or five cycles consisting of 5 days of paclitaxel, fluorouracil, hydroxyurea, and BID RT followed by a nine day break. RT dose to gross disease (high risk), intermediate, and low-risk volumes were reduced from cohort A (n = 68): 75, 60, and 45 Gy; to cohort B (n = 64): 75, 54, and 39 Gy; then cohort C (n = 90): 72, 51, and 36 Gy. RESULTS: A total of 222 patients accrued from November 1998 to September 2002. Median follow-up is 56 months. In all, 93/96/76% achieved a complete response to concurrent chemoradiotherapy (CRT) in cohort A/B/C. Three- and 5-year overall survivals (OSs) are 68% and 62%, respectively. Five-year LRC and DC are 91% and 87%, respectively. Response to IndCT predicted for OS, LRC, and time to progression (TTP). Cohort C patients had similar OS (P = 0.95), LRC, and DC, but worse (TTP) (P = 0.027). CONCLUSIONS: IndCT before CRT reduces distant progression while maintaining high LRC. The cohort B schedule provides the best therapeutic ratio. A randomized trial investigating IndCT before CRT has been initiated.
Authors: Jonas A de Souza; Darren W Davis; Yujian Zhang; Arun Khattri; Tanguy Y Seiwert; Serdal Aktolga; Stuart J Wong; Mark F Kozloff; Sreenivasa Nattam; Mark W Lingen; Rangesh Kunnavakkam; Kerstin M Stenson; Elizabeth A Blair; Jeffrey Bozeman; Janet E Dancey; Everett E Vokes; Ezra E W Cohen Journal: Clin Cancer Res Date: 2012-02-27 Impact factor: 12.531
Authors: Ezra E W Cohen; Theodore G Karrison; Masha Kocherginsky; Jeffrey Mueller; Robyn Egan; Chao H Huang; Bruce E Brockstein; Mark B Agulnik; Bharat B Mittal; Furhan Yunus; Sandeep Samant; Luis E Raez; Ranee Mehra; Priya Kumar; Frank Ondrey; Patrice Marchand; Bettina Braegas; Tanguy Y Seiwert; Victoria M Villaflor; Daniel J Haraf; Everett E Vokes Journal: J Clin Oncol Date: 2014-07-21 Impact factor: 44.544
Authors: Ezra E W Cohen; Daniel J Haraf; Rangesh Kunnavakkam; Kerstin M Stenson; Elizabeth A Blair; Bruce Brockstein; Eric P Lester; Joseph K Salama; Allison Dekker; Rosalyn Williams; Mary Ellyn Witt; Tatyana A Grushko; James J Dignam; Mark W Lingen; Olufunmilayo I Olopade; Everett E Vokes Journal: J Clin Oncol Date: 2010-05-24 Impact factor: 44.544
Authors: Ronald J Maggiore; Emily K Curran; Mary Ellyn Witt; Daniel J Haraf; Everett E Vokes; Ezra E W Cohen Journal: J Geriatr Oncol Date: 2013-06-10 Impact factor: 3.599