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Induction Docetaxel, Cisplatin, and 5-Fluorouracil Precludes Definitive Chemoradiotherapy in a Substantial Proportion of Patients With Head and Neck Cancer in a Low Socioeconomic Status Population

Caudell, Jimmy J., MD, PhD*,†; Hamilton, Robert D., MD; Otto, Kristen J., MD§,∥; Jennelle, Richard L., MD†,¶; Pitman, Karen T., MD; Vijayakumar, Srinivasan, MD

American Journal of Clinical Oncology: August 2014 - Volume 37 - Issue 4 - p 332–336
doi: 10.1097/COC.0b013e31827a7cff
Original Articles: Head and Neck
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Objectives: In this retrospective study we evaluate the tolerability and outcomes after induction chemotherapy for patients with predominately low socioeconomic status (SES) with locally advanced head and neck cancer (LAHNC).

Methods: One hundred eighteen patients with LAHNC of the hypopharynx, larynx, oral cavity, or oropharynx began curative intent therapy with induction cisplatin (75 or 100 mg/m2), docetaxel (75 mg/m2), and 5-fluorouracil (750 mg/m2×5 d or 1000 mg/m2×4 d; continuous infusion) every 3 weeks (DPF) for a planned 2 to 3 cycles. All patients were to receive curative radiotherapy with concurrent systemic therapy. Associations were tested using χ2 test, and survival estimates were calculated using the Kaplan-Meier method.

Results: Most patients (75.4%) were of low SES. Induction DPF was delivered for a median of 2 cycles (range, 1 to 3) and 14% of the patients (n=17) died during induction DPF. After DPF, 38.2% of patients were unable to complete or receive planned definitive therapy. Overall 15.3% of patients died during therapy, and mortality was associated with a Karnofsky performance status <80 (P=0.04). At 2 years the locoregional control was 52.7%, whereas the distant metastases free rate was 72.6%, and the overall survival rate was 34.1%. Low SES patients were less likely to achieve locoregional control (P=0.05) or survive (P=0.08).

Conclusions: In this population of LAHNC patients of low SES with a high tumor burden and poor performance status, use of induction DPF was associated with 15.3% mortality during therapy and precluded 38.2% of patients from initiating or completing planned definitive therapy.

Departments of *Radiation Oncology

§Head and Neck Oncology, Moffitt Cancer Center, Tampa, FL

Departments of Radiation Oncology

Medicine

Otolaryngology, University of Mississippi Medical Center, Jackson, MS

Department of Radiation Oncology, University of Southern California, Los Angeles, CA

The authors declare no conflicts of interest.

Reprints: Jimmy J. Caudell, MD, PhD, 12902 Magnolia Dr., Tampa, FL 33612. E-mail: jjcaudell@gmail.com.

© 2014 by Lippincott Williams & Wilkins, Inc