A prospective study of response and toxicity of induction chemotherapy followed by concurrent chemoradiation versus only concurrent chemoradiation in patients with locoregionally advanced unresectable head-and-neck cancer

ABSTRACT

Background: The first-line treatment for locally advanced squamous cell carcinoma of head-and-neck cancer is concurrent chemoradiation, which is the standard of care. Concurrent chemoradiation improved locoregional control but little impact on distance metastases. Induction chemotherapy (IC) can reduce local disease and distance metastases. Objectives: The purpose of our study is to compare the outcome of disease and toxicity between IC followed by concurrent chemo-radiation and only concurrent chemoradiation in patients of locally advanced unresectable head-and-neck cancer. Materials and Methods: A total of 37 patients were included in IC followed by concurrent chemoradiotherapy group. IC was administered with injection paclitaxel, injection carboplatin, and injection 5-fluorouracil for three cycles. Thirty-six patients were included in Arm B, concurrent chemoradiation group. The total dose of radiation was given in both the Arms 66 Gy in 33 fractions, five fractions per week for 6.3 weeks with concurrent chemotherapy injection cisplatin 40 mg/m2 weekly. Results: Grade 4 skin reaction was 2 (7%) in Arm A and 1 (3.3%) in Arm B. Grade 3 febrile neutropenia was 1 (3.4%) in Arm A and no Grade 3 febrile neutropenia was seen in Arm B. Grade 3 thrombocytopenia was 1 (3.4%) in Arm A and 2 (6.6%) in Arm B. Complete response of disease after 6 months of completion of treatment was 19 (65.5%) in Arm A and 18 (60%) in Arm B. Conclusion: Our study showed no significant difference in disease response regarding locoregional disease control between two groups but distance recurrence can be reduced with IC with manageable toxicity.