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Perri F.,National Tumor Institute of Naples | Ionna F.,National Tumor Institute of Naples | Muto P.,National Tumor Institute of Naples | Buonerba C.,University of Naples Federico II | And 8 more authors.
Anticancer Research | Year: 2013

Background: Cervical metastases from unknown primary tumors are rare and no clear therapeutic options are available. This retrospective analysis aimed to evaluate toxicity and activity of a sequential chemoradiation regimen consisting of induction chemotherapy followed by extendedfield radiotherapy in patients with cervical metastases from unknown primary tumors. Patients and Methods: Patients with cytological or histological diagnosis of latero-cervical lymph-node metastasis from carcinoma with unknown origin treated with sequential chemotherapy (3 cycles of docetaxel and cisplatin, each administered as intravenous infusion at the dose of 75 mg/m2 on day 1, every 21 days) and radiotherapy (cumulative dose of 70 Gy) were included in this study. The radiological response was assessed by central review according to the revised RECIST criteria. Results: Fifteen patients received three cycles of induction chemotherapy with the combination of docetaxel and cisplatin. Patients were subsequently treated with extendedfield radiotherapy. Three complete responses were observed after induction chemotherapy and 13 after the chemoradiation treatment. The overall response rate after chemoradiation, was 93.3% (14 of 15 evaluable patients). One year disease-free-survival was 83.3% (10 of 12 evaluable patients). Treatment was well-tolerated; two cases of grade 4 neutropenia, two of grade 3 mucositis and eight of grade 2 nausea were the worst, most clinically-relevant sideeffects. Conclusion: Induction chemotherapy followed by extended-field radiotherapy showed good activity and manageable toxicity in patients with cervical metastases from unknown primary tumors. Source


Perri F.,National Tumor Institute of Naples | Muto P.,National Tumor Institute of Naples | Argenone A.,National Tumor Institute of Naples | Ionna F.,National Tumor Institute of Naples | And 5 more authors.
Oncology (Switzerland) | Year: 2013

Objectives: To replace 5-fluorouracil with capecitabine within a trial of induction chemotherapy followed by cetuximab plus radiotherapy (RT) in patients with locally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN). Also, to replace cisplatin with cetuximab after induction chemotherapy. Methods: Docetaxel and cisplatin were given at 75 mg/m2, while capecitabine was initially given at 500 mg/m2 twice a day and subsequently escalated. The maximum tolerated dose was used for the phase II study. Results: Seven patients were enrolled. At dose level 1, two dose-limiting toxicities were observed in the first 4 patients (grade 4 neutropenia and grade 3 diarrhea). In both patients, capecitabine was withdrawn and toxicities resolved. Dose escalation was halted and a lower capecitabine dose (750 mg/m2 daily) was selected. Two complete responses and five partial responses were observed after induction chemotherapy. Four patients were evaluable for response after cetuximab-RT (3 complete response and 1 partial response). Conclusion: Combined chemoradiotherapy is still the gold standard in LA SCCHN and no studies currently support the use of early induction chemotherapy. Our study did not contribute toward addressing this issue since it was discontinued early because of toxicity. Copyright © 2013 S. Karger AG, Basel. Source

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