[Organ-preserving treatment in inoperable patients with primary oral and oropharyngeal carcinoma: chances and limitations]

Organ preservation treatment using TPF-a pilot study in patients with advanced primary and recurrent cancer of the oral cavity and the maxillary sinus

PURPOSE

Induction chemotherapy with Taxotere, cisplatin, and 5-fluororacil (TPF) was mainly used in hypopharyngeal and laryngeal cancer patients for larynx preservation. This study aimed to assess feasibility and toxicity in oral cavity and maxillary sinus cancer patients.

PATIENTS AND METHODS

Between 2003 and 2008, 21 patients (18 male, three female; mean age 58 years; 15 patients Eastern Cooperative Oncology Group > or =1) suffering from advanced squamous cell cancers of the oral cavity (seven primaries, eight locoregional recurrences) and the maxillary sinus (six patients) were prospectively treated with three cycles of TPF (q3w) and were scheduled to undergo definitive chemoradiation.

RESULTS

Of 21 patients, 15 (71%) could be treated with all three cycles, one patient with two cycles, and five patients with one cycle. Reasons for incomplete treatment were tumor progression, edema, seizure, bad general condition, sepsis, pneumonia (each once). The infections led to two treatment-related deaths (9.5%). Acute grade III/IV side effects were noted maximally in 11 patients (52%). Main toxicities were afebrile leukopenias and neutropenias and stomatitis. Of 15 patients, six and four patients had a clinical complete or partial remission following three cycles (67%); five patients with recurrences had no response. Ten patients underwent a definitive chemoradiation or radiation (47.6%). After a mean observation time of 17 months, nine patients are alive; one of them developed a local recurrence.

CONCLUSIONS

Chemotherapy with TPF is a highly effective treatment with considerable toxicity that needs special expertise which is best assured in a multidisciplinary setting. Pretreated recurrent cancers demonstrated bad response. A target for organ preservation could be the maxillary sinus; due to tumor regression in advanced oral tongue cancer, consecutively, a reduced function has to be encountered.

Überlebensverbesserung eines unizentrischen Gesamtkollektivs aus 20 Jahren

PURPOSE

The development of overall survival of a DOSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic's overall population comprising a time period of more than 20 years (1983-2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared.

METHODS AND PATIENTS

The data of the DOSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich.

RESULTS

The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.[Symbol: see text]e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population.

CONCLUSION

Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.