RESUMO
The aim of this study was to compare the result of application of induction chemotherapy followed by chemo-irradiation for treating locally advanced head and neck carcinoma in comparison with the former standard of concurrent chemo-irradiation. Between 2003 and 2006 we treated 74 patients with unrespectable [stage III and IV head and neck] cancer by two different protocols. The sequential protocol [Arm I], started with two courses of neoadjuvant chemotherapy [cisplatin + continuous infusions 5- fluorouracil [5-FU]], followed by a course of chemo-irradiation using conventional fractionation up to 70 Gy. The concomitant protocol [Arm II], Patients were given Cisplatin 100 mg/m[2] [D1, D22, D43]; concomitantly with a course of radiotherapy up to 70 Gy in conventional fractionation; Results from the two groups were compared. Patient and tumor characteristics were balanced [arm I=33, arm II =31 pts.]. Mean radiation dose achieved [66.3 Gy Vs. 69.6 Gy, p=0.001], response rates were [85% Vs. 88% for primary, p=0.4 and 79% Vs. 85% for lymph nodes, p=0.1]. Local control [LC; 33.5% Vs. 53.5%, p=0.04], was significantly lower in the sequential group, and overall survival [23% Vs. 38%, p=0.3] after 3 years. Acute toxicities grades III and IV predominate in the sequential group while late toxicity was similar in both groups. Concomitant chemo-irradiations is more effective in treating head and neck tumors than induction chemotherapy followed by chemo-irradiation, resulting in better local control and a trend towards improved survival