IS THERE ANY ROLE OF INDUCTION CHEMOTHERAPY IN UNRESECTABLE LOCALLY ADVANCED HEAD AND NECK CANCERS: AN INSTITUTIONAL DATA

Abstract

Background: Head and neck cancers are very common in India due to habit of betel quid and areca nut chewing along with bidi smoking and alcoholism, with more than half of the patients presenting in locally advanced stage. Chemo-radiotherapy with or without induction chemotherapy is the mainstay of treatment for these patients. We have performed a prospective study to determine the effectiveness of induction chemotherapy followed by concurrent chemo-radiotherapy.

Methodology: A total of 20 patients with unresectable locally advanced head and neck cancers were enrolled in the study. Treatment included two cycles of induction chemotherapy with Paclitaxel (135mg/m², day1) and Cisplatin (40mg/m² onday1, 2) at an interval of 21days followed by Cisplatin 40mg/m² weekly along with conventional radiotherapy (70Gy/35#/7weeks). The tumor response and acute toxicities were evaluated.

Results: Of the 20 patients, only 8 patients completed the planned treatment schedule. Of the 8 patients, radiological complete response was observed in 5 patients. The partial response was seen in 2 patients. One patient had progressive disease. Few grade 1 and 2 toxicities including skin toxicity, diarrhea, anemia, acute kidney injuryand peripheral sensory neuropathy were observed. Only 4 patients had grade 3 toxicities of acute mucositis, vomiting and neutropenia.

Conclusion: Sequential therapy incorporating induction chemotherapy and chemo-radiotherapy appears to be an inferior approach. Further investigations are required to select a better regimen in patients with unresectable locally advanced head and neck cancer.