Induction Chemotherapy Using Docetaxel, Cisplatin and Fluorouracil (TPF) Followed by Concomitant Chemoradiotherapy Vs the Same Concomitant Chemoradiotherapy in Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck (LASCCHN)

ABSTRACT Background Concomitant chemoradiotherapy (CCRT) with cisplatin is considered a standard treatment of LASCCHN. The role of induction chemotherapy (IC) followed by CCRT remains controversial. Our aim was to compare neoadjuvant chemotherapy with 3 cycles of TPF followed by CCRT to CCRT alone. The 1ry objective of the study was ORR and the 2ry objectives were toxicity, PFS and OS. Patients and methods Between 2006 & 2008, 100 patients with histologically proven SCC of the Head & Neck (stage IIB-IVA) were enrolled. WHO PS 0-1, with adequate bone marrow, liver and kidney functions. Fifty patients received 3 cycles of IC including docetaxel 75 mg/m2 IV over 1h D1, cisplatin 75mg/m2 IV over 3h D1 and 5-FU 750 mg/m2 IV continuous infusion over 24h D1-5 (repeated every 3 wks). Premedications before and after docetaxel and cisplatin with prophylactic antibiotic on D5 and G-CSF on D6. This was followed by CCRT in the form of radiotherapy using conventional fractionation (2Gy/day, 5 fr/week, total dose of 70Gy) with concurrent weekly cisplatin 20 mg/m2 IV (Gp A). In gp B, patients received CCRT alone. Response was assessed by physical examination, CT scan and endoscopy after 2 cycles, after completion of IC, and 6-8 wks after completion of CCRT. Results All patients in both gps had completed the treatment schedule and were evaluable for response, toxicity and survival. The median age was 44.5 years in both gps (range 27-62). Seventy percent of patients had PS 0, 65 patients had cervical LN involvement (N2-3). The ORR after the completion of CCRT were 88% & 68% in the two groups respectively. Toxicity was manageable in both groups. The main severe toxicities during IC were G3 alopecia and neutropenia. During CCRT, the most severe side effects in both groups were mucositis and weight loss. The 2-year PFS and OS rates were 70%, 86% and 75%, 80% respectively. Conclusion Induction chemotherapy using TPF followed by CCRT is safe, tolerable and effective treatment and can significantly improve survival in patients with LASSCHN. Disclosure All authors have declared no conflicts of interest.