Induction Chemotherapy Followed By Concurrent Chemoradiotherapy Versus Radiotherapy Alone In Locally Advanced HNSCC – An Experience From Medical College In West Bengal, India

Abstract

Introduction:

Locally advanced Head and neck cancers (LAHNSCCs) are emerging as an important public health issue in India. Our study was designed to provide NACT to LAHNSCC patients followed by comparison between chemoradiation versus only radiation in rural medical college.

Material and Method:

Histopathologically proven non-metastatic LAHNSCC were randomized into 2 arms. Patients in both arms initially received 3 cycles of NACT (inj Paclitaxel 175mg/m2 and inj Carboplation AUC 6, i.v, q 21 days). Thereafter they received definitive treatment accordingly: arm A (control arm) received conventionally fractionated radiotherapy (CFRT), 70 Gy in 35 # and in arm B (study arm) received conventionally fractionated radiotherapy (CFRT), 70 Gy in 35 # with concomitant 3 weekly cisplatin 100mg/m2. A RECIST v1.0 criterion was used for response assessment and toxicities evaluated by RTOG Acute and late Morbidity scorings.

Results:

Between July 2013 to December 2015, 140 patients were randomized into arms. Laryngeal and hypopharyngeal subsites together accounted for 36.4% patients. 70% of patients were in AJCC TNM 7th edition stage IV. 87.8% of patients completed the planned 3 cycles of NACT. Response assessment using RECIST v1.0 criteria after NACT were comparable in both arms with CR in 25% patients and PR in another 60% patients, p value 0.963. After completion of full treatment, 68.57% (48/70) patients in concurrent arm had CR against 55.72% patients (39/70) in only radiation arm, p value 0.241. At the end of study, 38 patients in arm A and 46 patients in arm B were eligible for response assessment. 24 patients (63.2%) in arm A were in complete response against 32 patients (69.6%) in concurrent chemoradiation arm, p value 0.535. Gastrointestinal and mucositis grade 3 toxicities were significantly increased in concomitant chemoradiation arm.

Conclusion:

Our study failed to show any statistical significant improvement in CR in favour of CTRT arm in our subset of patients. Yet definitive conclusion regarding use of only radiation cannot be made for LAHNSCC especially when combined with induction chemotherapy.