Concurrent Chemo-radiotherapy with Taxotere and Cisplatin in Head and Neck Cancer: A Feasibility Study

Background: For many years surgery was the cornerstone of treatment for head and neck cancers and radiotherapy was the treatment of choice in adjuvant and advanced inoperable settings. Recently, induction sequential chemotherapy followed by radiotherapy has shown good tolerability and has prolonged the median overall survival. This phase II trial explored the feasibility of the concurrent association with radiotherapy of a full-dose chemotherapy based on an original schedule of docetaxel and cisplatin. Patients and Methods: Twenty-four patients with head and neck squamous cell carcinoma (HNSCC) were enrolled. Taxotere (docetaxel) was administered on day 1, weekly for 6 weeks. The dose was 33 mg/m 2 /w. Cisplatin was administered on day 2 at the dose of 70 mg/m 2 . Radiotherapy delivered was 60 Gy divided in 30 administrations over 6 weeks. Results and Conclusion: This schedule of treatment for HNSCC proved feasible. Appropriate support treatment, however, appears to be necessary for the feasibility of this concurrent chemo-radiotherapy. Head and neck squamous cell carcinoma (HNSCC) is the most common malignant neoplasm of the mucosa of the upper aerodigestive tract. Nearly two-thirds of HNSCC patients present with advanced (Stage III or IV) disease and fifty per cent die of their disease (1). Accordingly, currently available therapeutic modalities (surgery, radiation and/or chemotherapy) need to be combined to achieve better survival results. For many years surgery was the cornerstone of treatment, while radiotherapy was the strategy of choice for head and neck cancer in adjuvant and advanced inoperable settings. In recent years, however, induction sequential chemotherapy with platinum compounds plus 5-FU followed by radiotherapy, usually hyperfractionated radiotherapy, has shown good tolerability and has yielded more satisfactory clinical benefit than radiotherapy alone (2- 4). Moreover, concomitant radio-chemotherapy with platinum analogs significantly prolongs the 3-year survival and median overall survival (OS) (5-7). New drugs are now entering the therapeutic arena, gemcitabine and taxanes being the most promising compounds. Little it is known, however, about how to associate these drugs with radiotherapy; moreover, toxicity assessment of the new protocols is essential, especially in an adjuvant setting.