Year: 2003
Type: article
Abstract: With regard to the letter by Drs. Haddad and Posner on our previous article,1 we observed Grades 3 and 4 neutropenia in 20 (37%) and 17 (31%) patients, respectively. Among 20 patients with Grade 3 neutropenia, no patients developed neutropenic fever, while 5 (9%) patients developed neutropenic fever among 17 (31%) patients who developed Grade 4 neutropenia. Five (9%) patients who developed neutropenic fever required either dose reduction or delayed one week of treatment of the next cycle of therapy. Grade 3/4 thrombocytopenia occurred in only three (6%) patients, and two patients required dose reduction for the next cycle of therapy. At the time of data analyses, the median followup was 22 months, and the range was 14 months to 31 months. The median time to starting radiation therapy after induction chemotherapy was 4.2 weeks (range, 3–6 weeks) in all patients who underwent radiation therapy. Nine patients underwent surgical resection after induction chemotherapy, followed by radiation therapy. Of these, three had resection of both primary sites and nodal sites, and six had resection of the lymph node sites only: one of three patients showed no viable tumors in the primary sites, and seven (78%) of nine patients who underwent neck dissection for node sites had no viable tumors on pathologic evaluation. All nine patients who underwent surgical resection right after induction therapy had either stable disease or progressive disease with induction chemotherapy. All responders (partial plus complete) to induction chemotherapy directly underwent radiation therapy without intervening with surgery. We agree with Haddad and Posner's concerns that there will be a potential chance of tumor repopulation in the surgical bed when surgery is performed between induction chemotherapy and radiation therapy.2, 3 Thus, only those patients who failed to respond to chemotherapy underwent surgery, since this group of patients may also be poor responders to radiation therapy as well. In this prospective study, pathologic assessment with biopsy for the partial responders after induction chemotherapy was not routinely performed, since all responders underwent radiation therapy regardless of tumor status at biopsy sites. However, if residual disease was suspected by head and neck examination or image studies after radiation therapy, biopsy was performed to evaluate for potential surgical salvage. With a median followup of 22 months, 43 (83%) patients were alive. If two patients were included in the denominator, the overall survival rate may decrease to 79%. However, one or two year overall survival and disease free survival rates would not be changed as reported. In terms of the value of ifosfamide in head and neck carcinoma, single agent ifosfamide produced response rates ranging from 20–30% in Phase II studies for recurrent head and neck carcinoma.4 Ifosfamide also has additive or synergistic effects with platinum or taxanes in preclinical studies.5 Dunphy et al. studied induction chemotherapy with paclitaxel and carboplatin for locally advanced head and neck cancer.6 Overall complete plus partial response of the study was 66%, whereas our study showed that 60% of patients had achieved complete response and 21% had partial response.1 Organ preservation was achieved in 28 of 62 (45%) of patients,6 while in our study, the organ preservation rate was 42 of 52 (81%) patients.1 Therefore, it appears to be additive or synergistic when ifosfamide is incorporated to paclitaxel/carboplatin regimen, although direct comparison in a randomized fashion has not been conducted. Dong M. Shin M.D.*, * University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Source: Cancer
DOI: 10.1002/cncr.11215
Author: Dong M. Shin
Institution: UPMC Hillman Cancer Center
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4248162594