Conventional chemoradiation vs. induction chemotherapy followed by conventional chemoradiation for locally advanced head and neck cancer: A prospective, randomized study

The standard‐of‐care in locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) remains concurrent chemoradiotherapy. The present study compared the disease response and safety profile of induction chemo‐ therapy followed by concomitant chemoradiotherapy (CRT) vs. CRT alone in patients with LA SCCHN. The present prospec‐ tive randomized study was conducted between July, 2014 and July, 2015 on 52 patients with SCCHN of the oropharynx, hypopharynx and larynx. Patients were randomly divided into the induction chemotherapy [docetaxel, cisplatin and 5‐FU (TPF)] followed by CRT arm (TPF + CRT arm, n=25) or the CRT alone arm (CRT arm, n=27). The disease response, and acute and late toxicities were assessed. At the first follow‐up (6 weeks), the overall response rate (ORR) was 82.6% for the TPF + CRT arm and 72% for the CRT arm; the difference was not significant. In addition, no statistically significant differences were observed in the nodal response between the treatment arms. Acute toxicities were significantly higher in the TPF + CRT arm, with respect to mucositis and hemato‐ logical toxicities. No differences were observed in late‐onset toxicities observed following 3 months of radiotherapy. Triple drug‐based sequential therapy was tolerable in the popula‐ tion in the present study and may thus hold promise for the treatment of SCCHN; however, larger prospective studies are required to confirm these results. Introduction Head and neck cancer is the sixth most common type of cancer worldwide (1), with ~500,000 new cases diagnosed annually. It constitutes 5% of all cancer cases worldwide. In India, head and neck cancer accounts for 29.6% of all cancer cases among males (range, 24.3‐34.3%) and 11.84% of all cancer cases among females (range, 10.5‐15.5%) as per different hospital‐based registries (2,3). Squamous cell carcinoma of the head and neck (SCCHN) constitutes >90% of all head and neck cancers (1). In India, SCCHN arising from the oral cavity is the most common type of cancer among males and the third most common type among females (1,4). Approximately, 16% of all cancer cases were registered as SCCHN at the Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India, from 2001 to 2010, accounting for 10.6% of all cancer cases among males and 5.4% of all cancer cases among females (unpublished data). The geographic distribution reveals a very large variation in the incidence of head and neck cancers in different countries, with low incidences reported in Western Europe and high incidences in South Asia, parts of Africa and South America (5). The incidence of early‐stage SCCHN (stage I or II) is ~40%, whereas 60% of cases are reported with locally advanced (stages III and IVA/B) and metastatic (stage IVC) disease (6). Therapeutic options for early‐stage SCCHN include both surgery and radiotherapy as a single treatment modality, with a cure rate of ~80% (6,7). Radiotherapy alone has long been the standard non‐surgical therapy for locally advanced disease (8,9). A previous meta‐analysis of individual patient data from >10,000 participants in 63 trials [Meta‐Analysis of Chemotherapy on Head and Neck Cancer (MACH‐NC)] demonstrated that the addition of chemotherapy to radio‐ therapy in both definitive and adjuvant postoperative settings resulted in a 12% reduction in the risk of mortality from head and neck cancer, corresponding to an absolute improvement of 4% in the 5‐year survival rates (10). The use of induction chemotherapy followed by radiotherapy has resulted in organ preservation without compromising overall survival, when compared with radiotherapy alone in the Conventional chemoradiation vs. induction chemotherapy followed by conventional chemoradiation for locally advanced head and neck cancer: A prospective, randomized study AMIT RANA1, PRIYANKA RANA2, MANOJ GUPTA3, RAJEEV SEAM4 and MANISH GUPTA1 1Department of Radiotherapy, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh 171 001; 2Directorate of Health Services, Shimla, Himachal Pradesh 171 009; 3Department of Radiotherapy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249 203; 4Department of Radiotherapy, Maharishi Markandeshwar University, Ambala, Haryana 133 203, India Received May 28, 2020; Accepted August 24, 2020 DOI: 10.3892/wasj.2020.65 Correspondence to: Dr Priyanka Rana, Directorate of Health Services, Shimla, Himachal Pradesh 171 009, India E‐mail: dramitrana1982@gmail.com