Sequential Therapy with Induction Chemotherapy Followed by Concurrent Chemoradiation in Locally Advanced Squamous Cell Carcinomas of the Head and Neck

Introduction: Induction chemotherapy in locally advancedhead and neck cancers prior to local therapy has beendemonstrated to be non-inferior to concurrent chemoradiationin terms of overall survival (OS). Despite possible lack ofsurvival advantage, downsizing of tumours, allowing organpreservation along with the possible benefit of eradication ofmicrometastases earlier in the course of therapy makes thisa desirable approach for many heads and neck oncologistsworldwide. Study aimed to assess the immediate locoregionalresponse rates and to assess the toxicity profile of sequentialtherapy with three cycles of induction PFT followed byConcurrent Chemo-Radiation with weekly Cisplatin inLocally Advanced Head and Neck Cancers.Material and methods: 30 consecutive patients with locallyadvanced head and neck cancers attending the OPD at ourinstitute were included in the study. All patients were treatedwith 3 cycles of Induction chemotherapy with PFT regimen(Paclitaxel 175mg/m2 Day1, Cisplatin 100 mg/m² split to(Day 1-3), 5-FU 750 mg/m² Day 1 to 3) every 21 days. Thepatients were then taken up for concurrent chemoradiation(66 Gy RT along with weekly Cisplatin 40mg/sq.m.). Theimmediate locoregional response rates were assessed byclinical and radiological imaging. The toxicity profile of thetreatment was assessed with RTOG acute morbidity scoringcriteria and CTCAE Version 4.Results: 30 patients (3 female) were recruited for the study.Among them 3 were laryngeal cancer patients and thehypopharyngeal, oropharyngeal and the oral cavity cancerswere 9 each. 63% of them had complete response and 30%had partial response. The sub-sites of the hypopharynx andthe oropharynx had the best outcomes from this treatmentprotocol. 2 patients did not complete the planned treatment.11patients had grade 3 leukopenia and 2 patients had grade 4/febrile neutropenia. There was no grade 3 thrombocytopeniain the study group.Conclusion: Sequential therapy with three cycles of inductionPFT followed by concurrent chemoradiation is a feasiblealternative for moderately advanced and very advanced headand neck cancer. Patient selection and supportive care duringtreatment are very important for successful outcome.

Treatment of Locally Advanced Squamous Cell Carcinoma of Head and Neck with Hybrid Accelerated Radiotherapy and Concurrent Chemotherapy

Introduction: Head and neck cancer is the most common cancer in India. Overall, 57.5% of global head and neck cancersoccur in Asia, especially in India. Even though anatomical subsites of head and neck regions are accessible to clinicalexamination, 60–80% of patients in India report with locally advanced disease in comparison with developed countries whichis 40% only.Concurrent chemoradiation remains the standard treatment approach in locally advanced head and neck cancers.Conventional radiation schemes with 3 weekly cisplatin produce a response rate of 50–60% only in locally advanced head andneck cancer. Studies reveal that tumor clonogen repopulation might be one of the most important factors determining treatmentoutcome. Various retrospective studies and clinical trials have shown that an increase in tumor control can be achieved byshortening treatment time using altered fractionation schemas.Aim: In this present work, we made an attempt to improve the therapeutic ratio by hyperfractionation and accelerated radiationregimens.Methods: To achieve the above, 30 patients of locally advanced squamous cell carcinoma with different disease status werechosen. Patients subjected to hybrid accelerated radiotherapy with total dose of 72 Gy along with cisplatin 100 mg/m2 were givenon day 1 and day 22. Complete response rate in primary T2, T3, and T4 tumors is 100%, 86.95%, and 16.67%, respectively.Results: Complete response rates attained by N0, N1, and N2 nodes are 100%, 100%, and 50%, respectively. 16.6% hadGrade 2 mucositis and 50% had Grade 3 mucositis. 80% had Grade 3 and 20% had Grade 2 skin toxicities. No Grades 3 and4 hematological toxicities such as anemia, leucopenia, or thrombocytopenia were observed.Conclusion: Hence, we suggest that combination of hybrid accelerated radiotherapy and cisplatin mono-chemotherapy, withmanageable, although substantial, toxicity as an effective alternative regimen to treat head and neck cancer