Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck

Long-term results

John R. Clark, Paul M. Busse, Charles M. Norris, Janet W. Andersen, Arnon I. Dreyfuss, Renée M. Rossi, Mark D. Poulin, A. Dimitrios Colevas, Roy B. Tishler, Rosemary Costello, James W. Lucarini, Donna Lucarini, Lee Thornhill, Melissa Lackey, Edward Peters, Marshall R. Posner

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Purpose: A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA). Patients and Methods: One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed. Results: Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free, including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%. Conclusion: PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

Original languageEnglish (US)
Pages (from-to)3100-3110
Number of pages11
JournalJournal of Clinical Oncology
Volume15
Issue number9
StatePublished - Sep 1997

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Induction Chemotherapy
Leucovorin
Fluorouracil
Cisplatin
Neoplasms
Survival
Radiotherapy
Carcinoma, squamous cell of head and neck
Chemoradiotherapy
Disease Management
Anatomy
Hospitalization
Neck
Therapeutics
Survival Rate
Biopsy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Clark, J. R., Busse, P. M., Norris, C. M., Andersen, J. W., Dreyfuss, A. I., Rossi, R. M., ... Posner, M. R. (1997). Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: Long-term results. Journal of Clinical Oncology, 15(9), 3100-3110.

Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck : Long-term results. / Clark, John R.; Busse, Paul M.; Norris, Charles M.; Andersen, Janet W.; Dreyfuss, Arnon I.; Rossi, Renée M.; Poulin, Mark D.; Colevas, A. Dimitrios; Tishler, Roy B.; Costello, Rosemary; Lucarini, James W.; Lucarini, Donna; Thornhill, Lee; Lackey, Melissa; Peters, Edward; Posner, Marshall R.

In: Journal of Clinical Oncology, Vol. 15, No. 9, 09.1997, p. 3100-3110.

Research output: Contribution to journalArticle

Clark, JR, Busse, PM, Norris, CM, Andersen, JW, Dreyfuss, AI, Rossi, RM, Poulin, MD, Colevas, AD, Tishler, RB, Costello, R, Lucarini, JW, Lucarini, D, Thornhill, L, Lackey, M, Peters, E & Posner, MR 1997, 'Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: Long-term results', Journal of Clinical Oncology, vol. 15, no. 9, pp. 3100-3110.
Clark, John R. ; Busse, Paul M. ; Norris, Charles M. ; Andersen, Janet W. ; Dreyfuss, Arnon I. ; Rossi, Renée M. ; Poulin, Mark D. ; Colevas, A. Dimitrios ; Tishler, Roy B. ; Costello, Rosemary ; Lucarini, James W. ; Lucarini, Donna ; Thornhill, Lee ; Lackey, Melissa ; Peters, Edward ; Posner, Marshall R. / Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck : Long-term results. In: Journal of Clinical Oncology. 1997 ; Vol. 15, No. 9. pp. 3100-3110.
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abstract = "Purpose: A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA). Patients and Methods: One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed. Results: Among 279 courses, the overall response rate was 81{\%}. Nineteen (19{\%}) failed to respond, including three who died during therapy. Sixty-seven (69{\%}) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84{\%}) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19{\%} of cases. After definitive local-regional therapy, 84 (82{\%}) were disease-free, including 71 (69{\%}) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58{\%}, 52{\%}, and 51{\%}. Local failure occurred in 29 of 102 (29{\%}) and the local control rate at 5 years was 68{\%}. Conclusion: PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.",
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T1 - Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck

T2 - Long-term results

AU - Clark, John R.

AU - Busse, Paul M.

AU - Norris, Charles M.

AU - Andersen, Janet W.

AU - Dreyfuss, Arnon I.

AU - Rossi, Renée M.

AU - Poulin, Mark D.

AU - Colevas, A. Dimitrios

AU - Tishler, Roy B.

AU - Costello, Rosemary

AU - Lucarini, James W.

AU - Lucarini, Donna

AU - Thornhill, Lee

AU - Lackey, Melissa

AU - Peters, Edward

AU - Posner, Marshall R.

PY - 1997/9

Y1 - 1997/9

N2 - Purpose: A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA). Patients and Methods: One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed. Results: Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free, including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%. Conclusion: PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

AB - Purpose: A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA). Patients and Methods: One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed. Results: Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free, including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%. Conclusion: PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

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