A prospective comparision of sequential chemoradiation vs concurrent chemoradiation in locally advanced oropharyngeal carcinomas.
OBJECTIVE
Induction chemotherapy has shown to provide consistent benefit for local control in primary treatment of advanced oropharyngeal cancer. The beneficial role of chemoradiation following induction chemotherapy over concurrent chemoradiation has not been evaluated. Present study evaluates the same prospectively.


RESULTS
The response rate and acute toxicity (primary end points) in both the arms were found to be similar (p > 0.05) The points disease free survival and overall survival (secondary end points) were significantly (p < 0.05) better in treatment arm as compared to control arm.


METHODS
Out of 135 patients of locally advanced oropharyngeal carcinoma, 105 patients were found eligible and randomized to treat either with induction chemotherapy consisting of 2-3 cycles of cisplatin and 5-Florouracil followed by low dose weekly cisplatin based chemoradiotherapy (treatment arm: n = 48) or chemoradiotherapy only (control arm: n = 57). The primary tumor and regional lymph drainage areas received 66-70 Gy in 6.5 to 7 weeks by fractionated dose schedule.


CONCLUSIONS
Patients receiving chemoradiation following induction chemotherapy showed better response rates both in terms of complete response and disease free survival at two years than those receiving only concurrent chemoradiation but at the cost of manageable increase in toxicity.
Gupta
Deepak
D
Department of Radiotherapy, Chhatrapati Sahuji Maharaj Medical University, Lucknow, India. deepakonco@gmail.com
Shukla
Pragya
P
Bisht
Shyam Singh
SS
Dhawan
Ankur
A
Pant
Mohan Chand
MC
Bhatt
Madan Lal
ML
Gupta
Seema
S
Gupta
Rajeev
R
Negi
Mahendra Pal Singh
MP
D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D011838:Radiation-Sensitizing Agents; D002945:Cisplatin; D005472:Fluorouracil